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Why Most Significant Eye Bags Cases Would Require Surgery Over Cosmetic Fillers
Why Most Significant Eye Bags Cases Would Require Surgery Over Cosmetic Fillers

A 28-year-old woman has under eye bags. She is unsure which route to go: cosmetic fillers or surgery.

Dr. Amiya Prasad, a cosmetic oculoplastic surgeon who specializes in eyelid surgery, does a lot of under eye bags treatment. Being able to do both the surgery and the fillers, he shares how to make the decision. Looking at this woman’s photo, he says that there is a significant amount of puffiness under her eyes. This anatomic change is called lower eyelid fat prolapse. Lower eyelid prolapse means that the puffy bags represent fat that is normally behind a structure called a septum. However, this fat shifted forward and created these permanent bags.

There are different degrees in which the puffy bags prolapse forward. A typical history is when a patient says that they have a lot of good days, but occasionally some bad days. This means that there’s a little bit of puffiness and there are times when they see it more. Those patients tend to benefit with filler because there’s not a lot to camouflage. The point of a filler is to soften the contrast between the puffy bags and the adjacent tissue in the tear trough or the eyelid-cheek junction. Dr. Prasad can strategically and artistically soften this area with the use of a filler such as a hyaluronic acid.

As a specialist, Dr. Prasad gets to see a lot of people who have puffy under eye bags and had too much filler placed under their eyes. This is because a well-meaning doctor wanted to try to help them to avoid surgery and they end up with so much volume of hyaluronic acid under their eyes that they actually look even puffier and weird. To help these patients, he uses hyaluronidase which is an enzyme to break the hyaluronic acid down and make it disappear.

When a patient is young, they naturally have hesitations as to cosmetic surgery. However, puffy under eye bags are not the same category as surgeries related to facial aging. Dr. Prasad has operated on people as young as 14 for under eye bags because under eye bags are a genetic issue.

Dr. Prasad does his procedures in his own Joint Commission approved facilities. This is the same certifying body that approves hospital facilities. He is committed to safety and ensuring that his patients have no less quality of care. Having surgery done in his office is a friendlier and less threatening atmosphere than someone going in to a hospital. On the top of that, he does the procedure under local anesthesia with LITE™ IV sedation. This means that patients don’t have general anesthesia and they feel comfortable that they’re not going to be on a respirator. He also can do these procedures on straight local anesthesia with patients wide awake. The safety record has been great and there has never been an issue.

In addition, people are also afraid of bruising and swelling after surgery. Over 20 years, Dr. Prasad is able to effectively minimize bruising after surgery. There are many times people see him after one week after surgery and they virtually have no bruising at all. In fact, patients can get more bruising with injectables than surgery, but this is on a case-by-case basis.

Based on this woman’s photo, she is probably a candidate for surgery. Another objection people have is a fear of scars and they desire to avoid external scars that show they had surgery. The procedure that Dr. Prasad typically does for under eye bags is transconjunctival blepharoplasty which is done from the inside of the eyelid. Through this he is able to reduce and reposition the fat as is appropriate to get a natural appearance and there’s no external incision. People feel comfortable and confident that no one would ever know that they had surgery.

Dr. Prasad explains that under eye bags make such a tremendous impact on a person’s facial appearance. It’s no secret that it’s one of the most popular he does in his practice. It’s literally like doing a facelift where the eyes become brighter, more open and not looking tired. It really brightens up the whole face. He suggests that she should meet with qualified experienced surgeons and learn about her options. She should make sure that she goes to someone who is a real expert in eyelid surgery. He has always been a firm believer in specialization and helping the patients get the best results, and this is through seeing people who are really experienced in any particular surgery. It’s no secret that surgeons who do a particular thing a lot tend to do them very well. She also has to look at the artistic style and whether or not she is comfortable with the doctor.

For more information on transconjunctival blepharoplasty, go to:

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

Stopping Hair Loss & Thickening Hair Non-Surgically in the 20s is Advised Over Hair Transplants
Stopping Hair Loss & Thickening Hair Non-Surgically in the 20s is Advised Over Hair Transplants

A 24-year-old male has severe baldness in less than a year. He wants to know if hair transplantation is the right option for him.

Dr. Amiya Prasad, a hair restoration specialist, explains that in the years past, it was rare in his practice to ever do a hair transplant on someone in their 20s because they were losing hair so fast that they would never get close to the volume and coverage that they would be satisfied with, even after 2-4 transplants. In the later decades, so many men in their 40s or 50s have hair loss that transplant can be done more strategically.

A diffuse pattern of hair loss has miniaturization. The hair does not fall out necessarily but with every growth cycle, the hair comes back thinner. There is actually a lot of existing hair if someone were to look under the microscope.

There are several options for hair loss. One can orally take a drug like finasteride which is a blocker of dihydrotestosterone or DHT, the byproduct of an enzyme called 5-alpha reductase. Certain hair follicles are susceptible to the effect of DHT. Therefore, if DHT is reduced in the system, the progression of hair loss is slowed down. At this current time, people are very hesitant because this drug has been associated to have long-term sexual side effects.

In Dr. Prasad’s practice, he has developed Hair Regeneration, a method of using a material called extracellular matrix combined with the patient’s own blood byproduct called platelet-rich plasma. He has developed a delivery system and a method of formulation to make a significant improvement in restoring their volume without surgery. It’s a onetime injection treatment and he has 3-5 years of data supporting the longevity and the lack of regression. Patients are coming to him from all over the world because of this unique system.

Dr. Prasad advises against doing a hair transplant. If someone is losing hair so fast, their hair transplant will look like they had a hair transplant. He suggests to try a medical modality instead such as oral drugs or Hair Regeneration because they’ll get more benefit from them. In Dr. Prasad’s practice, he observed practically a 100% improvement in the patients who come to him. The earlier someone comes, the more he is able to help and get them a lot more benefit.

Dr. Prasad has also helped a lot of people who recently had a hair transplant and are looking for a way to improve their results. Through Hair Regeneration, they have a better yield and overall result from their transplant. He is able to thicken up their thinning hairs so that they are not continuously losing hair.

Dr. Prasad suggests that he learn more about Hair Regeneration and he advises against doing a transplant. He doesn’t think it would be the right thing for this man.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Why a Specialist for Eye Bag Removal Surgery Reduces Surgical Risks and Gives Better Results
Why a Specialist for Eye Bag Removal Surgery Reduces Surgical Risks and Gives Better Results

A 52-year-old male has under eye bags. He wants to know if there are non-surgical options for him.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years. He thinks the non-surgical approach for eye bags has been the holy grail for dealing a straightforward anatomic issue. The bags under the eyes are caused by fat prolapse. Since it’s fat, it’s a physical volume that has to be approached surgically.

There has been a real trend in the world of cosmetic surgery for the past 30-40 years and that is towards specialization. There has been a study about surgeons who specializes versus generalists. It shows that a specialist with a focused area has more experience and usually gets more consistent and better results. If a general surgeon does a lot of hernia surgery, they will also have a lot of experience in that area. This means if a surgeon is focused in area, the complication rates become lower. It also means that they accept more complex cases.

When patients come to Dr. Prasad’s practice, they are also concerned about complications and undesirable results. However, they are more confident when they know about his background of eye surgery and specialization in plastic surgery of the eyes and his experience of 20 years. In his informed consents, he states there that there are risks, but they are unlikely because this is what he does every day. Dr. Prasad explains that looking for a non-surgical alternative is not going to be successful. As surgeons, they wouldn’t dress and do this type of work if there was a non-surgical alternative.

Dr. Prasad suggests that this man should gauge his level of comfort and confidence with his doctor. He needs to know if his doctor does a lot of this surgery, if he has great results, if he feels comfortable with him, and does he feel confident that his surgeon would do a great job for him. He should have this discussion with his doctor and see what the relative risks are and if he's willing to accept them. Eyelid surgery is one of the most popular cosmetic surgical procedures. Studies show that general plastic surgeons tend to have a higher rate of complications than specialists. It’s more about individual surgeons and their style. No specialty has all the best talented people.

For more information on transconjunctival blepharoplasty, go to:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-face-eyes-nyc-new-york/eyelifts/transconjunctival-blepharoplasty/

How to Choose Between Cosmetic Fillers or Surgery to Treat Puffy Eye Bags and Dark Circles
How to Choose Between Cosmetic Fillers or Surgery to Treat Puffy Eye Bags and Dark Circles

A woman has dark, puffy circles under her eyes. She wants know whether cosmetic filler or lower eyelid surgery is best to treat her.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, explains that this is a problem he deals with every day. The puffiness under the eyes is typically a hereditary issue called lower eyelid fat prolapse, meaning the fat normally around the eyes pushes forward, prolapses and herniates. Addressing this fat needs some type of surgical procedure. There have been different non-surgical modalities introduced that have failed completely because they simply don’t work. There is some benefit of fillers in patients who have some slight bit of fat coming forward, but for most people they have too much fat moving forward.

In Dr. Prasad’s practice, he routinely performs a procedure called a transconjunctival blepharoplasty. Through this, he addresses the fat pockets from the inside of the eyelid. This avoids an external scar or incision and the shape and stability of the lower eyelid is maintained, which are very important factors when dealing with lower eyelid puffiness. There’s no sign that the patient had surgery. He’ll remove and reposition fat as is appropriate so patients get this nice, natural contour as if they never had the fat pockets to begin with.

With dark circles under the eyes, there are many different solutions being offered. Patients will be hit with different types of creams, and some medical or pseudo medical devices. Dark circles have to do with a combination of genetics and environment. Some people who have a darker complexion have a tendency for dark circles. Environmental causes include: sun exposure, smoking, eye rubbing and various types of stresses.

With wrinkling and fine lines that occur with the breakdown of the skin, Dr. Prasad tries to restore the skin in terms of its health using platelet-rich plasma. Platelet-rich plasma is derived from the patient’s own blood, like a simple blood draw in a doctor’s office or a lab. He spins the blood and concentrates the critical factors needed for healing. When this is injected under the skin of the eyelids, it improves the skin quality by generation of collagen and new blood supply.

The other aspect of the darkness has to do with the relative contour which often has to do with the anatomy. In terms of the skin, it’s just the position of the bone and tear trough. It is also related to the presence of allergies or sinus issues that creates pooling of blood under the eyes that result in pigmentation often referred to as allergic shiners. Dr. Prasad tries to enhance the volume by placement of a combination of a hyaluronic acid filler like Restylane, and combine it with platelet-rich plasma.

Dr. Prasad recommends that she meet with qualified, experienced cosmetic surgeons and learn about their approach. His strategy is to address the puffy bags under the eyes through transconjunctival blepharoplasty, which he performs routinely under local anesthesia with LITE™ intravenous sedation in his Joint Commission-approved facilities. This way, patients avoid general anesthesia altogether. He also will use platelet-rich plasma at the same time so that she can the reduction of the puffy bags and an improvement of the skin quality. If after surgery she still has the desire to enhance the tear troughs, Dr. Prasad can then apply fillers like Restylane combined with PRP.

For more information on transconjunctival blepharoplasty, go to:

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

To know more about platelet-rich plasma, please visit:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/platelet-rich-plasma/

To learn more about hyaluronic acid fillers like Restylane, please go to:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/restylane-perlane/

Why Hair Thinning at 19 Signals Rapid Hair Loss, and a Treatment to Stop Hair Loss Progression
Why Hair Thinning at 19 Signals Rapid Hair Loss, and a Treatment to Stop Hair Loss Progression

A 19-year-old gentleman is experiencing thinning hair. He wants to know if hair transplant surgery would be effective for him, and appropriate at his young age.

Dr. Amiya Prasad, a hair restoration specialist, explains that the early onset of hair loss is very often an aggressive type of hair loss. He sees patients from all over the world for his hair loss treatment and he certainly sees younger and younger people. Male pattern hair loss is a genetically determined trait. There’s a program loss or thinning process that goes on.

In the past, the only options were oral medications like finasteride or a topical like minoxidil and hair transplantation surgery. It’s certainly an option for someone to try finasteride. For some younger men, it will slow down the progression but it will not stop it. Often, people who have this early onset tend to not respond to finasteride. At the current time, many people are not taking finasteride because of concerns of long-term sexual side effects.

In Dr. Prasad’s practice, he developed Hair Regeneration using a material called extracellular matrix. Extracellular matrix is used for wound healing. He has been able to create a formulation combining this with a byproduct of the patient’s own blood called platelet-rich plasma. Through this, he is able to stop the progression of hair loss in close to 100% of men who come to him for male pattern hair loss. Not only is he able to stop the progression, but he is also able to reverse the thinning. That means that hair that was thinning and disappearing is becoming thicker. He has hundreds and hundreds of patients who are the living proof of the benefit of this treatment.

Dr. Prasad suggests that this gentleman learn more about Hair Regeneration. At the minimum it will at least stop the progression. With 3-5 years of data, he has seen the benefit and the longevity. Unlike some doctors who are doing something similar and doing this with several injections, he does this with a single session, then he observes his patients very closely. He sees people every 3 months and he does very objective observations with photography and microscope photos. He has not seen anybody regressing.

Dr. Prasad always states that his patients tend to do better when they come in early, from the time of the onset of their hair loss. The time of onset of hair loss and the progression are two factors. A man who starts thinning in their 30s can still have hair well into their 30s. However, there are many younger men who start thinning in their teens and in their 20s, then become bald between the age of 20 to 23. Therefore, onset and rate of progression are very important factors. The sooner someone comes in, the better off they are because he can save the hairs that are existing. Often he can’t see them with a microscope because they are in a quiescent or the telogen (resting) phase of hair growth. Hair that has been gone for a long time cannot be salvaged.

Dr. Prasad suggest that he learn more about Hair Regeneration and medical treatments such as finasteride and minoxidil, then meet with qualified and experienced professional for a consultation.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Why People Still Lose Hair after a Transplant, and How to Prevent Hair Loss
Why People Still Lose Hair after a Transplant, and How to Prevent Hair Loss

A 33-year-old male wants to restore and lower his receding hairline. He wants to know a procedure with lasting results.

Dr. Amiya Prasad, a hair restoration specialist, explains that male pattern hair loss is a dynamic process. This means that even if someone had a transplant, they will continue to lose hair. There are two limitations of a hair transplant: a patient needs more than one transplant in order to achieve a certain amount of density, and the limited amount of hair in the donor area. Also, regardless of hair transplants, people will continue to lose hair. The donor area is the area of hair that doesn’t go away. It’s a genetic resistant area where hair can be transplanted from, but it has a limited number of hairs and the area is very narrow.

Finasteride is a commonly prescribed drug that’s supposed to slow down the progression of male pattern hair loss, but it does not work on everyone, or the same way for everyone. Currently, people don’t want to take finasteride because of the long-term sexual side effects associated with the drug.

For years, the standard approach to transplant was a strip method where a strip of the donor area would be removed, then cut into grafts, then placed. It had a certain amount of yield and it had a variable amount of take based on multiple factors. Since people didn’t like the scars, the industry shifted to FUEs or follicular unit extractions. However with FUEs, the surgeon has to go beyond the safe donor area to yield the same number of grafts that they would with the strip, resulting in taking hairs that are at risk of thinning. In addition, even with the best of hands and advanced robot technology, it is going to transect or cut the hair without the root and placing it. 30% transection rate is not unusual in FUE surgery, and 65% of patients will be dissatisfied with the density based on a published study by the International Society of Hair Restoration Surgery.

In Dr. Prasad’s practice, he developed Hair Regeneration, a combination approach of using a material called extracellular matrix then combining that with a fraction of the patient’s blood called platelet-rich plasma. With this, he has been able to reverse the hair thinning process in a way that far exceeds the volume and the coverage of hair transplants. When people come to him, he tends to not recommend hair transplants but rather to do Hair Regeneration. When patients do this injection treatment, most people decide they’re happy and they don’t want a hair transplant. They have saved themselves the cost, the inconvenience, the risk of surgery and the need of additional surgery. If someone wants a transplant because they are more advanced in their hair loss, he can now confidently move the grafts and place them. He uses the extracellular matrix to improve the benefit, the yield of the transplant, and be confident that they’re not going to be losing hair. He has patients coming from all over the world who are seeking treatment and doing the treatment and avoiding hair transplant all together.

Dr. Prasad explains that patients can try to lower their hairline but the density that they need to look natural is rarely achievable with hair transplantation. They need anywhere from 70-100 hairs per square centimeter which nature creates. When they do a transplant, it’s really not possible even with multiple transplantations to get that same type of density. When they don’t have density, it looks like they had a transplant because the hair continues to thin and they can see hair plugs.

Dr. Prasad suggest that he learn more about the options about taking medical therapies such as finasteride and Hair Regeneration before deciding on a hair transplant. He has to understand that he is not in a stable state and will to continue to progress.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit: http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Different Types of Facelift Procedures for Sagging Facial Skin and Neck Lifting
Different Types of Facelift Procedures for Sagging Facial Skin and Neck Lifting

A 50-year-old woman has lost a lot of weight. She wants to know if she needs a full facelift or a simpler, less invasive procedure.

Dr. Amiya Prasad is a cosmetic oculofacial surgeon practicing for over 20 years. He does a lot of facelifts and has seen a lot of changes of what the term facelift means, and how marketing and terminology has confused a lot of people. He could see from this woman’s photos that there is a loss of definition of the jawline and there’s extra skin under the chin which extends further down along the neck. When he does a physical exam, he vertically lifts the face and pull behind to see how much of this area improves.

There are many types of terminologies that doctors use such as short scar facelifts, standard facelift, face and necklift. Dr. Prasad differentiates these first by the size of the incision. A short scar facelift is literally a short incision made in the ear area, usually behind the opening of the ear. This is meant to vertically lift, elevate and improve the jawline. It can be very effective to do a lot through a relatively small incision. A full facelift in Dr. Prasad’s practice involves an incision above the ear, in the temple and go slightly behind the ear to lift the cheek to the jawline and part of the upper part of the neck. Lastly, the face and neck lift involves an incision the same as the facelift then goes behind the ear and extends to put traction on the neck skin which is sagging down. From the photos, Dr. Prasad thinks she would be a candidate for a face and necklift.

When doing these procedures, there should be a balance: the patient’s desired outcome, what they accept as a satisfactory result, combined with the level of surgery they are willing to do, the healing time involved and lastly, the cost involved.

In Dr. Prasad’s practice, he tries to reduce a lot of the negatives that are associated with face lifting surgery. He does the procedures under local anesthesia with LITE™ sedation. Regardless of whether or not it’s a short scar facelift or deep plane facelift combined with cheek implants, chin implants and more extensive work, he does everything under local anesthesia with sedation. Patients feel very comfortable about avoiding general anesthesia altogether. He also individualizes procedures for patients and focuses on the style.

Sometimes, the type of incision the patient needs are done during the surgery because Dr. Prasad looks under the skin and the tissue that is very important called the SMAS. The SMAS is the superficial musculoaponeurotic system which is tissue over the facial muscles that transfers the tip of the muscles to the skin. The SMAS is like the foundation that's a continuation of the muscle called the platysma. When it sags, the skin sags with it so the surgeon just can’t lift the skin alone. They have to also elevate the SMAS in whatever way appropriate. There are many ways to do it and it always goes back to what the individual surgeon finds works best in their hands.

In addition, there’s a common concern about scars. So in addition to meticulous quality surgery, Dr. Prasad also uses a material called extracellular matrix which has been very successful for hair loss. It originated in cosmetic procedures to help improve the healing. It’s really been remarkable to get fantastic healing using this material.

Dr. Prasad thinks that this woman must evaluate the level of facelift she is willing to do and what she thinks is a satisfactory result. He always cautions his patients that it’s one thing to be conservative but most of time, people really want nice results. He tends to be more on the aggressive side to try to get the most optimal results. Unfortunately, even with that, there’s always a natural amount of regression with the elasticity of skin that sometimes require some enhancements. In his practice, he always offers his patients the option of doing enhancements if needed. He has his own facilities and is able to absorb a lot of those costs that could be a barrier or obstruction for someone.

Dr. Prasad suggests that she should meet with qualified experienced cosmetic surgeons. There are a lot of people who do facelifts and she has a lot of options at this time. She can learn the type of facelift that she likes by looking at the doctor’s before and after pictures. She can also look at the style and get a sense of the staff, and the level of happiness the patients experience when they had their procedures. Once she feels comfortable, she can move forward with the procedure that she thinks would be the most beneficial for her.

For more information about Face lifting surgery, please visit our website:

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

How Hollow Under Eyes & Dark Circles are Treated with a Combination to Add Volume and Thicken Skin
How Hollow Under Eyes & Dark Circles are Treated with a Combination to Add Volume and Thicken Skin

A woman has dark circles under her eyes. She wants to know the best treatment for it.

Dr. Amiya Prasad, a practicing oculofacial plastic surgeon for over 20 years, says that in the past doctors were frustrated because dark circles under the eyes could not be managed with anything more than attempting to lighten them with bleaching creams or another type of external treatment. Presently, he has developed his own process of addressing dark circles.

The dark circles are the result of an area of hollowing called the tear trough. This depth makes the eyes look like they’re tired and there is hollowing. In addition, when the skin is relatively thin and very light, people are practically seeing directly to the bone or the muscle. Eyelid skin is the thinnest skin in the body at half a millimeter of thickness, anything below the eyelid skin is almost transparent.

Dr. Prasad has had a lot of success using a combination treatment based on two concepts: addressing skin quality and volume. Skin quality under the eyes can be improved using a material called platelet-rich plasma. Platelet-rich plasma is the growth and healing factors derived from the patient’s own blood. He draws blood like in a lab, then spins the blood to concentrate the platelet-rich plasma. These healing factors stimulate collagen, blood supply and improve the skin quality. In a way, it improves the thickness and the overall healthiness of the skin. The second and most important part is the volume where Dr. Prasad uses hyaluronic acid filler such as Restylane. There is always an art to doing this such as the placement and the viscosity of the hyaluronic acid. He has been successful in combining the hyaluronic acid filler to fill the tear trough with platelet-rich plasma to improve skin quality. It’s been well documented in medical studies on wound healing that there’s a synergy when combing platelet-rich plasma with hyaluronic acid so that wounds heal better. He has also observed the same thing in his practice that this combination helps make the under eye area look better.

The challenge here is not only the placement or getting the results that the patient desires, but also the maintenance. The hyaluronic acid will eventually break down and disappear. There is some evidence of some residual fibrovascular tissue remains for a longer term, but nonetheless the bulk of the hyaluronic acid volume effect does require some maintenance. What Dr. Prasad has observed is a variability of how long it will last between individuals. Certain factors can cause an acceleration in the degradation such as cigarette smoking. If someone smokes, they tend to break everything down because carbon monoxide and the free radicals are so damaging that it can cause a breakdown of the material.

Dr. Prasad always observes his patients very closely. He routinely does this first treatment and sees his patients 2 weeks later to make sure everything looks right. He’ll see people on a regular basis so that he can see when the material breaks down. It has not been unusual for patients to come in every 6 months to have it done and there have been patients where it lasted up to 2 years.

Dr. Prasad thinks that a combination approach is exactly what he would do in our practice for patients like this woman. He would use hyaluronic acid and platelet-rich plasma. There is also a role for external topicals such as retinols and really good quality moisturizers.

Dr. Prasad suggest that she meet with experienced and qualified specialists who do a lot of work in the under eye area. There are a lot of gimmicks lately about trying to improve the dark circles and a lot of it has to do with topical creams and the use of blunt cannulas and other things that make it seem like there’s a superiority there. The key is knowing the anatomy, how to do this and having the experience to formulate this combination in the most effective way, which comes just from doing this a lot. She should meet with doctors and see if she is comfortable and try this solution. It’s a relatively low risk solution since there isn’t a surgery or a permanent implant or anything of that nature.

For more information about injectable hyaluronic acid fillers, please visit our website:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/

To learn more about platelet-rich plasma, please visit:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/platelet-rich-plasma/

Why Fat Grafts for Hollow Under Eyes is Cautioned, and Treating Puffy Eye Bags
Why Fat Grafts for Hollow Under Eyes is Cautioned, and Treating Puffy Eye Bags

A man has dark eye bags and his surgeon is suggesting orbital fat removal for the eye bags, and a fat graft for the adjacent hollowing. He wants to know if these are the right procedures for him, or if only one procedure is needed.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, specializes in eyelid surgery, facial rejuvenation surgery and hair loss treatment. Eyelid surgery is one of the things that he does a lot. He explains that anyone who performs surgery of any kind has their own approach and style. He can’t disagree with a colleague with another approach works well for them.

The challenges in the anatomy of the eyelid are the fat prolapse, with adjacent hollowing that occur with aging. From Dr. Prasad’s experience, addressing the fat pockets or the prolapsing fat with a transconjunctival blepharoplasty significantly improves the appearance of tired looking eyes. He always explains to his patients that what causes the tear trough to look so deep is the adjacent deep trough next to the prolapsed fat. The contrast between the elevation and the depression is further accentuated.

Dr. Prasad’s hesitation with the use of fat transfer is based on a lot of experience. Fat is not predictable and he doesn’t think any surgeon can guarantee they can deliver the fat the exact way they want it placed. Fat is a graft, meaning that it’s separated from another part of the body and placed under the eyes. Surgeons anticipate that a certain amount of blood supply will allow the fat to be integrated and become viable. Unfortunately, 30-70% of fat will be absorbed. From his experience, a lot of fat will actually become inflamed and scarred creating irregularities and lumpiness.

In Dr. Prasad’s practice, he counsels his patients to address the lower eyelid puffiness first. Most of the time, people don’t need excess skin removal. In addition, he’ll inject platelet-rich plasma to try to improve the skin quality and address the dark circles. After all this is done and she’s still bothered by the tear trough, he’ll combine Restylane or hyaluronic acid filler with platelet-rich plasma and very specifically mold the area of the tear trough to get a very nice result. However, that does require maintenance. From his experience and style, Dr. Prasad likes the predictability of this combination treatment. When there’s a potential risk of an undesirable appearance from a procedure that outweighs the benefits, it’s not worth doing. Dr. Prasad uses fat grafting in other areas such as the hands for hand rejuvenation or in the nasolabial folds of the lower face where the skin is thicker. He doesn’t place it under the very thin and delicate eyelid skin where it can be very obvious or disappear altogether. Often, people who have fat placed under the eyes will have problems with chronic swelling.

Dr. Prasad’s suggests that probably discussing the merits of fat under the eyes and the timing of the procedure are worth discussing with this man’s surgeon.

For more information on transconjunctival blepharoplasty, go to:
http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/
To know more about platelet-rich plasma, please visit:
http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/platelet-rich-plasma/

To learn more about hyaluronic acid fillers like Restylane, go to:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/restylane-perlane/

What to Do for Puffy Eyes, Dark Circles, and Under Eye Hollowing
What to Do for Puffy Eyes, Dark Circles, and Under Eye Hollowing

A 33-year-old man always looks tired. He hides the problem with makeup but it still shows. He also has hollowness and half circles that bother him. He wants to know how to make his eyes look fresh and young.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon who specializes in eyelid surgery and face lifting surgery. Rejuvenating tired-looking eyes is what he does every day. When patients like this man come in for a consultation, he first tries to learn a little about why his eyes look so tired. He would ask if he is smoker because people who smoke tend to accelerate the aging process. Smoking is incredibly destructive to fine delicate tissues in the body. He would ask if he has seasonal allergies, if he is rubbing his eyes a lot, or if he is under a lot of stress. If he is a smoker, then stopping smoking is to his advantage. The other parts of it have to do with lifestyle such as adequate sleep, diet and exercise. Things that are good for someone’s heart and lungs are also good for the face and eyes. If he sleeps enough, exercise, doesn’t smoke and has no issues with allergies, then most likely what he’s dealing with is a genetic issue.

The puffiness under this man’s eyes is the most significant issue. The puffiness is called lower eyelid fat prolapse which means that the fat that is normally around the eyes pushes forward and creates these bulges. These bulges result in a constant look of fatigue. Even if someone uses creams, make-up or other types of non-surgical modalities, they simply won’t work.

In Dr. Prasad’s practice, he typically treats lower eyelid fat prolapse with a transconjunctival blepharoplasty. This is a method of addressing the fat pockets from the inside of the eyelid to avoid an external scar. There is no sign of any procedure done from the outside and no one would know that the patient used to have the puffy bags. He also often combines this procedure with modalities such as platelet-rich plasma (PRP) which is deriving the key growth and healing factors from the blood to stimulate new collagen and improve skin quality under the eyes. He also uses thermal energy such as fractional co2 laser to help improve the external skin quality. Lastly, he would also add to the regimen some topical skin products such as a good moisturizer, sunblock and maybe something for cell turnover like a retinol product. Other areas of relative hollowing can be addressed but Dr. Prasad usually defers that after the surgery.

When Dr. Prasad performs the surgery, he performs it in his Joint Commission-approved facilities within his practices in Manhattan and Long Island. He does this under local anesthesia with LITE™ IV sedation. This means patients avoid general anesthesia altogether so they are able to recover quickly and go back to work as early as within a week.

Dr. Prasad explains that this man’s upper eyelid skin doesn’t appear to have that much redundancy to the point where there’s hooding. In terms of the relative contribution to the fatigue appearance, he would say that focusing on the lower eyelids would be a good way to get the most value, especially when someone wants to apply their resources strategically. He suggests that it’s best he meet with qualified, experienced cosmetic surgeons and learn about his options.

For more information on transconjunctival blepharoplasty, go to:

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

For information on platelet-rich plasma, go to:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/platelet-rich-plasma/

For more information about fractional CO2 laser, please visit:

http://prasadcosmeticsurgery.com/dr-amiya-prasad-medi-spa-nyc-new-york/laser-light-treatments/microfractional-co2/

My Facelift Journey - From Retirement to Miss New York Senior America 2014
My Facelift Journey - From Retirement to Miss New York Senior America 2014

The Decision

Rose Scalia, is 64-years-old. She has worked in the real estate industry most of her life in the human resources department. She is also an adjunct professor in New York University. She did some research prior to coming to Dr. Prasad and even looked into fast facelifts. The facelifts she found had a lot of pressure to make a sale. Those types of facelifts had no opportunity for patients to meet the surgeon assigned them on the day of the surgery, and Rose wanted to meet her surgeon. She wanted to know who would be handling her face. She believes that the face is her cover and that’s very important to her. She did some research and found Dr. Prasad through her hairdresser, her friend who had her eyes done. She wanted to know the best surgeon who can do the best work, and also listen to what she wants and make expectations clear.

Rose decided that she was going to Dr. Prasad for a consultation. She was welcomed to an office that was aesthetically distinguished and pleasant. She met with Nicole, the receptionist, who made her feel welcome, which is important to her. She then met with Ania who would go over the details, what was needed, how they would proceed, and then meet with Dr. Prasad. Her first impression of Dr. Prasad was his smile. A smile is so welcoming and it makes someone feel warm and cared for. That was the first thing that she liked about Dr. Prasad. He asked her what she would like to do. She thought of herself as having a tired look and she wanted to match her face with the inner energy that she had. What she found out, which was very important for her, was a doctor who listens to her. Most important, Dr. Prasad provided options such as things she needed done and not done.

Moreover, Dr. Prasad had a wonderful array of credentials: he was board certified, and artistry was in him. He studied art and applies that sense of style by looking at the person’s face. He does a fantastic job by making a person 's unique characteristics shine. He looks at something in someone’s face that perhaps can be enhanced. Rose thinks that the traditional approach to surgery is wonderful, but the personalization that she had and the treatment and the education she received from Dr. Prasad elevated him to the next level because of his artful insight. That impressed her most and she decided to put herself in the hands of Dr. Prasad and his team.

The Experience

Rose's fear was not of the surgery but the fear of the anesthesia that they would use. She did not know what they would use, but Dr. Prasad explained to her that the anesthesia or the sedation was like that of a colonoscopy, so it’s a very light sedation. They give her medication to make her feel calm, and she just felt like taking a nap. Then they brought her to the operating room where she felt so comfortable. The team gave her everything she needed, then started to tell her the process. By that time, she’s almost napping. The sedation applied which is extremely light made for a pleasant experience. Her surgery took about 2 hours: Dr. Prasad takes his time with the prep, the surgery and the post.

The Results

Rose honestly recalls her experience the moment she woke up. She woke up laughing with the wonderful nurses. Jeff and Gloria took good care of her and were very attentive. When she woke up, she even asked if it was over. She didn’t feel a thing but just a little soreness but no pain around the ears. She suggests that if patients follow Dr. Prasad’s orders and what they need to do after the surgery, they will absolutely be fine. Dr. Prasad’s staff walked her out, which for her was a very kind gesture.

When she went back on Sunday, Dr. Prasad took his time from his family to remove the bandage from Rose's face. She was pleasantly surprised with the results. Dr. Prasad explained that there could be bruising. The stitches behind the ear were so tiny that people couldn’t even see them.

The Pageant

It was one year since Rose underwent facial rejuvenation with Dr. Prasad and his professional team who made her feel so comfortable. The reason why she chose to do a facial rejuvenation was because she didn’t want that tired outlook, especially when she knew she was close to retirement. Just four months ago, at the age of 64, she retired. She calls this her rejuvenation phase which is a time to go out and accomplish opportunities someone would never think or have time to do when they are at work. So, on April 27, 2014, she entered the Miss New York Senior America Pageant. She won Miss Congeniality. Her platform which was very important to her was, “make your age work for you”. She believes that everyone should be at the top of whatever they do and look best in all situations. She really wants to thank Dr. Prasad and his professional team for helping her age work for her.

Eye Bag Removal Surgery that Leaves no Sign of Surgery, and Improving Under Eye Skin
Eye Bag Removal Surgery that Leaves no Sign of Surgery, and Improving Under Eye Skin

A woman has hereditary under eye bags. She wants to know the type of blepharoplasty recommended for her age because she doubts that fat transfer is the answer for her.

Dr. Amiya Prasad, an oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, addresses under eye bags every day. Genetics is a very big factor in the presence of eye bags. It is related to the anatomic structure of the septum or the sheet that separates the front of the eye from the back of the eye. In under eye bags, there is fat behind the septum. When fat pushes forward, it’s called herniated fat. A lot of patients try creams, tea bags and all kinds of different things and find out that none of them work because this an anatomic issue.

There are two ways to address the fat pockets: one is from the outside called the transcutaneous blepharoplasty and another from the inside called the transconjunctival blepharoplasty. For someone like this woman, Dr. Prasad would typically do a combination of things to address the different aspects of lower eyelid rejuvenation. He addresses the fat pockets and also the skin quality and the volume issues that also coincide with this puffiness. He commonly does a transconjunctival blepharoplasty to sculpt and reposition the fat from the inside of the eyelids. He would combine that with platelet-rich plasma (PRP) which is derived from the patient’s own blood. PRP has a concentration of the growth factors that are used for healing. By placing these growth factors under the skin, it generates collagen and improves the blood supply to the skin. It adds a nice quality to the under eye area which often has a lot of shadowing and wrinkling. He also uses fractional CO2 laser as there's a role for a limited amount of thermal energy to tighten and stimulate collagen from the external approach, and also to refresh the top layer of the skin.

Dr. Prasad agrees that fat transfer is not the solution for her. He has many colleagues who tried in vain to use fat to augment and restore volume. Part of the basis of this is the fact that people lose fat and volume in the cheek and in the facial structure as they get older. Unfortunately, the skin doesn’t tolerate that much volume and 30-70% of fat transferred can be absorbed by the body. There is also sequential inflammation and scarring that can create irregularities and lumps. He has had patients who come from all over the world who have had fat transfer and requested that he try to remove this fat. It is technically very challenging and it is always a more complex operation than doing a lower eyelid blepharoplasty.

In addition, Dr. Prasad performs these procedures under local anesthesia with LITE™ IV sedation, meaning he doesn’t use general anesthesia. He performs these procedures in his own Joint Commission-approved facilities. Therefore, he basically has the benefits of a hospital structure, equipment, process and personnel.

Addressing under eye bags really makes a remarkable difference in a person’s appearance to look less tired and more energetic. It’s almost like doing a facelift without doing a facelift. Dr. Prasad recommends that she meet with some qualified experienced cosmetic surgeons and find someone who resonates with her.

For more information on transconjunctival blepharoplasty, go to:

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

How Asian Eyelid Surgery Can be Affected by Aging, and the Right Time for a Revision
How Asian Eyelid Surgery Can be Affected by Aging, and the Right Time for a Revision

A woman had her first double eyelid surgery done 27 years ago that resulted in both eyes being uneven. As time went by, both eyelids dropped. She had her second revision 3 weeks ago and it left her eye looking significantly older. She wants to know if she needs to consider a third revision.

Dr. Amiya Prasad, a specialist in eyelid surgery who focuses a lot in Asian eyelid surgery, explains that it’s not unusual to see a scenario like this in a second or third surgery. He explains that when she had her original Asian eyelid surgery, she probably had more fat and thicker skin when she was younger. The original surgery probably involved removal of a little skin and fat. It also involved anchoring of the skin to the levator muscle, the muscle that lifts the eyes which is responsible for the crease. As a lot of Asians get older, they lose volume and fat in the orbital space, do what was once an area of fullness becomes relatively hollow. In Dr. Prasad’s practice, many patients who had this situation occur and paradoxically, he places a filler to add volume and to create the fullness right below the eyebrow in order to create that shape.

For concerns about the appearance at this point, Dr. Prasad explains that she must understand that at 3 weeks, there are a lot of dynamic changes occurring and it is not uncommon for people who have Asian eyelid surgery to be concerned about swelling, irregularities and asymmetry at this stage. If her surgeon was an experienced cosmetic surgeon focusing on eyelid surgery for Asians, then typically they’ll have more than enough experience to know what to anticipate and to help her get through this transition phase. One can’t necessarily draw longstanding conclusions about what is going to happen 3 to 6 months from now. In Dr. Prasad’s practice, he tells his patients that it takes 6 months to a year for full healing, so she doesn’t want to do something prematurely.

When Dr. Prasad performs eyelid surgery, whether it’s ptosis surgery or in some cases of Asian eyelid surgery, he’ll actually have the patient open and close their eyes during the surgery to see how they look. Through this, he gets a good sense whether or not the shape of the eye is responding to what he is trying to achieve.

With that being said, Dr. Prasad thinks it’s important that she communicate with the doctor she trusted to perform the surgery and get a sense of what’s going on and why there’s a difference between the two eyes. He suggests that it’s reasonable to observe for the next couple of months how things settle out. Sometimes, a little enhancement is necessary but at 3 weeks after the surgery, she doesn’t want to draw conclusions that would ultimately probably resolve themselves on their own.

For more information about Asian eyelid surgery, please visit our website: http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/asian-eyelid-surgery/

If Ptosis Does Not Block Vision, then Ptosis Correction Surgery is a Matter of Preference
If Ptosis Does Not Block Vision, then Ptosis Correction Surgery is a Matter of Preference

A man has ptosis since he was young. He wants to know which operation he needs to correct his eyelid.

Dr. Amiya Prasad, a specialist in eyelid surgery and an oculoplastic surgeon, says that eyelid ptosis is a very common issue that he deals with. In congenital ptosis ,or ptosis acquired at birth, it’s important to make a decision about correction based on visual development prior to the age of 6. However, after age 6, it becomes about the aesthetics and symmetry. Patients can get a sense of whether or not lifting the eye interferes with their visual function by manually lifting the affected upper eyelid. Dr. Prasad thinks that he should have a full ophthalmic evaluation to see what the best procedure is to correct his vision in both eyes and see the impact of lifting his eyelid.

There are conditions such as amblyopia where the visual function of one eye doesn’t develop because of partial occlusion and lack of stimulation of the eye before age of 6. It is usually not a problem because it’s more about the aesthetics. Assuming he can tolerate the eyelid being open, Dr. Prasad thinks the choice of when to do surgery is a personal choice. If the drooping eyelid bothers him enough, then having a procedure makes a sense. He always tells his patients with ptosis that they’ll have a minimum of 3 operations in their lifetime: one will be when they’re very young for functional reasons, the second will be in their teens to twenties for cosmetic reasons, and the third on the later decades because everything starts to droop and the eyelid needs to be lifted again.

In this man’s situation, Dr. Prasad says he has to see what kind of ptosis surgery is appropriate for him. There’s ptosis surgery that’s based on good muscle function and there’s surgery based on poor muscle function. Depending on that, he would figure out whether to shorten the levator muscle, the muscle that lifts the eyelid, or whether to do something called a frontalis sling. This procedure is when the eyelid is attached through a connection between the eyelid margin and the eyebrow so that when the eyebrow is raised, the eyelid opens.

Another thing that Dr. Prasad does in his practice for patients who are not children and are old enough to cooperate is doing ptosis surgery with local anesthesia with LITE™IV sedation. He lets the patient be awake for the adjustment of the eyelid. This is a specialized area, and a tricky thing about ptosis surgery is achieving the optimal shape, contour and height so that there’s maximal symmetry. He tries to achieve symmetry by having his patients sit up during the surgery. They never feel any pain but at least they are able to try to judge whether or not the eyelid would be stable and looks good with gravity factored in. Ptosis surgery can turn out to be very gratifying for the patients and make a tremendous difference in their appearance and confidence. Getting some opinions from professionals and specialists such as oculoplastic surgeons or oculofacial plastic surgeons will give him an idea of what his options are.

To learn more about ptosis surgery, please visit:

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

How Fluid Causes Temporary Puffy Eyes, and Why Constant Eye Bags are Caused by Fat
How Fluid Causes Temporary Puffy Eyes, and Why Constant Eye Bags are Caused by Fat

A woman is wondering what can be done to smooth out the bags under her eyes. She wonders they can be drained using a needle.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, has a background training in eye and cosmetic surgery. Eyelid and eye bags surgery are things he does every day. When puffiness under the eyes is constant and is always puffy, that puffiness is actually fat and not fluid in a condition called lower eyelid fat prolapse. This means that the fat that is behind the eye or surrounds the eye pushes forward like a hernia. The reason why a lot of people confuse this with fluid is because allergies, sinus problems and eye rubbing can all cause the eyes to look temporarily puffy due to fluid. When bags are always there, then it's not likely due to fluid but caused by fat.

In Dr. Prasad’s practice, he typically addresses the problem first with a physical examination to confirm the puffy bags are due to fat. He performs a procedure such as a transconjunctival lower eyelid blepharoplasty. This is a procedure which is performed from the inside of the eyelid to address the fat pockets. This means resection or removal and repositioning as is appropriate. In addition, he uses platelet-rich plasma (PRP)which is derived from the patient’s own blood and helps improve the quality of the skin by generating collagen and blood supply. It also improves the health of the skin because the eyelid skin is the thinnest skin in the body, and improving this quality is very beneficial. Sometimes he also does fractional CO2 laser to help the external skin structure and to reduce the fine lines and wrinkles.

At this point, Dr. Prasad thinks that she should meet with qualified experienced surgeons and learn about the options. The thing he can’t do with a photo is a physical exam. He explains that it’s very important to understand the function and the support structure of the eye before undergoing lower eyelid surgery. As a specialist, he deals with complications of lower eyelid surgery every week and people come to him from all over the world for resolution. Performing a physical exam such as a snap test to determine the integrity of the eyelid support is critically important. He always says that lower eyelid surgery is deceptively oversimplified by many doctors, which unfortunately often results in the eyelid being pulled down or everted.

For more information on transconjunctival blepharoplasty, go to:

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

How Ptosis (Drooping Eyelid) can Develop Over Time and after Previous Double Eyelid Surgery
How Ptosis (Drooping Eyelid) can Develop Over Time and after Previous Double Eyelid Surgery

A man had Asian blepharoplasty when he was 17. However, he feels that her eyelid has begun to droop over the past years. He wants to know the type of procedure he would need.

Based on the single photo he submitted, oculoplastic surgeon Dr. Amiya Prasad says that he does have some degree of ptosis. Ptosis means drooping of the eyelid or the position of the eyelid margin relative to the center of the pupil. There’s a certain level that’s normal, and below that, based on the number of millimeters, is the degree of ptosis.

Before determining what kind of surgery to perform, it is important for patients to at least see an ophthalmologist or oculoplastic surgeon to diagnosis ptosis. New onset of ptosis should involve some kind of medical workup. There are neurologic and other causes of ptosis that should be eliminated before moving forward with the surgery. It is more likely that this man may have some degree of ptosis that was congenital or he was born with it. Over these past few years, the eyelid drooped a little further to the point that it is apparent to him.

Dr. Prasad respectfully disagrees that taking away skin in her upper eyelids would make his eyelid look more open. This is a very common difference between specialists in eyelid surgery and non-specialists. A lot of plastic surgeons would see this as common excess skin, but when patients look at the eyelid margin and imagine taking away a little excess skin or even rolling up the skin, they would see the eyes don’t look more open.

In Dr. Prasad’s practice, once he has established the diagnosis of ptosis related to the levator muscle, he performs ptosis surgery. Ptosis surgery is performed under local anesthesia with LITE ™ intravenous sedation. This type of surgery is very tricky because the muscle is very sensitive. Getting the right contour, height, shape and symmetry are very challenging. Dr. Prasad routinely lets his patients sit up during these procedures and have them look up and down during the surgery. Of course, they don’t feel anything but with their cooperation, he is able to get a better sense of what the contour will be when all of the anesthetic and everything else has worn off. He’ll even have the patient look at a mirror so that they see how open their eyes look.

Dr. Prasad suggests that this man get a proper examination. He must have the eyelid and the muscle function measured as part of a ptosis evaluation. Once this is established, there is a discussion about the type of ptosis surgery involved and he can now move forward with a procedure to open his eyes more. Prior to doing that, he must get at least a formal opinion of a specialist about the cause of his ptosis.

For more information about Asian eyelid surgery, please visit our website:

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

To learn more about ptosis surgery, please visit:

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

How Long Facelift Surgery Lasts, and Options for Neck Lifts and Facial Fat Transfer
How Long Facelift Surgery Lasts, and Options for Neck Lifts and Facial Fat Transfer

A 66-year-old woman had a successful facelift 20 years ago. However, she feels she has a sad face and loose neck, and is confused about what is best procedure for her.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that facial aging is an ongoing process and there’s continuous loss of bone, muscle and fat. Patients can have procedures that have long-term benefit that can last a while. Regardless of what procedure is done, facial aging will not stop.

If a patient’s objective is to improve the chin area or the submentum, submentoplasty or Z-plasty and platysmaplasty are all procedures that describe ways to improve the neck angle. On the other hand, a typical neck lift involves incision behind the ear and some parts in front of the ear and lifting the skin and the platysma. It also tightens it to get improvement of the angle. Submentoplasty or Z-plasty and platysmaplasty may not be as effective as a necklift. Z-plasty involves removal of skin and changing the vectors of tension so that patients don’t get a straight scar that can widen. The skin can be challenging, so Dr. Prasad has gotten fantastic results from it, but also in doing the same procedure has gotten thickened scars, so there’s a risk involved with the procedure. He has been able to help patients with thickened scars using a method of to soften them using platelet-rich plasma and extracellular matrix to revise the scar. A submentoplasty can also involve work done without the Z-plasty by going underneath the chin and working on the muscular layer and the other types of muscles called the digastric muscles.

The other procedure called a platysmaplasty is working on a muscle called the platysma. It is indicated particularly when there are platysma bands, the two neck bands that tend to be in the center. Dr. Prasad does a small opening, go inside and tightens the muscle of the platysma and does some other work to get the neck angle to improve.

To be able to make the right recommendation, Dr. Prasad stresses the importance of a physical examination. From the photo, it looks like she has a little extra skin, but in the absence of a physical examination it’s hard to make a recommendation.

Aqua Lipo is a different way to take fat out but it’s still essentially fat grafting. This is taking fat from one place and putting it in another place and hoping that the volume of fat will hold. Every doctor who does this can say that between 30-70% of the fat can get absorbed. Dr. Prasad always tells his patients who are considering fat transfer that they’ll need at least two procedures. He can place as much fat as he needs to, but that fat has to survive. He does all kinds of things such as the use of platelet-rich plasma and other modalities to try to maximize the survival. When tissue is separated from a blood supply and placed somewhere else, there is going to be variability in the take.

When patients cannot afford to spend a certain amount to maintain their appearance, it can be frustrating. Aesthetics are an area where someone can spend a lot of money. Dr. Prasad usually tells patients that whatever stage of their life they are in, they need to allocate a certain amount of budget. They might be better served with spending less on a regular basis to get the benefits that they desire rather than spending on surgery which has the implication that it will last longer. Yes, the facelifts can benefit anywhere from 10-20 years, but they are very variable.

Dr. Prasad suggest that she has to learn more about this and to be honest with herself on how much she can afford. She must meet with doctors who can be honest with her about the outcome and whether or not she’ll be satisfied. He always tells his patients who come for consultations that he’d rather not do a procedure than do a procedure where they’re paying less but getting less of an actual procedure and not being happy with the results. It’s all about communication and being able to set expectations.

For more information about Face lifting surgery, please visit our website:

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

Hair Regeneration Non-Surgical Hair Transplant Alternative that Can Stop Further Hair Loss
Hair Regeneration Non-Surgical Hair Transplant Alternative that Can Stop Further Hair Loss

Hair Regeneration is changing hair restoration as a non-surgical alternative to hair transplantation. For the past few years, the Hair Regeneration System developed by New York hair restoration specialist Dr. Amiya Prasad has consistently proven to provide better hair density and more natural-looking results than almost any hair transplant. Unlike a hair transplant, Hair Regeneration can stop progressive hair loss. None of the patients in this video had hair transplant surgery. Hair Regeneration has shown visible results in almost 100% of male patients (who are candidates) , and over 80% of female patients who suffer from pattern hair loss.

Hair transplantation is limited by the number of hairs available in the donor area (permanent zone in the back of the scalp). The donor area where hair grafts are taken can yield between 1500 to 4000 hairs per transplant session. When you first notice hair loss, it’s generally understood that you’ve lost over 50,000 hairs (more than 50% of your hair). This means that a hair transplant is limited to strategically placement since the procedure only moves a fraction of hairs in comparison to the hair that’s been lost.

Hair Regeneration works by thickening hair that has progressively thinned. Hair thinning in men is in some men is the result of hormonal effects on susceptible hair follicles. This hormone is dihydrotestosterone (DHT). Unfortunately, as with several patients seen in the video many people who take DHT inhibitors (finasteride/Propecia®) do not see any benefit. This means that DHT is not the only cause of hair thinning and hair loss in men. Hair Regeneration has resulted in visible hair growth and hair thickening in many patients who did not respond to finasteride/Propecia®.

There are drugs on the market for hair loss treatment : finasteride/Propecia® and minoxidil/Rogaine®. Oral medication finasteride inhibits the enzyme 5-alpha reductase that prevents the conversion of testosterone to dihydrotestosterone (DHT) to prevent hair thinning caused by hormones (androgentic alopecia). However, there are concerns of sexual side effects related to finasteride use. Finateride is limited only to men. Minoxidil delays the shedding phase of the hair growth cycle to keep more hair on the head longer for men and women, but does not address hair thinning or hormonal causes. If use of these hair loss drugs are discontinued, positive hair effects on hair will stop after a few months, and the patients revert to the appearance of their hair before medical therapy started.

Hair Regeneration is an injection treatment that appears to last 3-5 years. Some patients with more advanced hair loss have benefited from a second treatment. Hair Regeneration is not a drug. The formulation by Dr. Amiya Prasad consists of wound healing materials extracellular matrix (ECM) by ACell, and platelet-rich plasma (PRP) derived from your own blood. In addition vitamin D is added based on research from the University of Tokyo, as well as other customized ingredients, Hair Regeneration triggers the body to produce active adult stem cells which appears to restore healthy hair follicle function. The effect is the thickening of existing hair and reversal of the hair thinning process. One thing Hair Regeneration cannot do is bring back hair that is completely lost. Since hair progressively thins before being totally lost, Hair Regeneration can help most people with actively thinning hair. Early treatment is advised to maximize hair coverage.

Hair Regeneration also works to help people who recently had a hair transplant, or in conjunction with a hair transplant to heal the donor area incision. Hair Regeneration helps to stop further hair loss of native thinning hair and improve the survival of transplanted hair grafts.

To see how Hair Regeneration has helped even more people suffering from hair loss, visit:

http://nyhairloss.com/hair-regeneration-acell-ecm-prp-photos-by-dr-amiya-prasad/

Preventing the Need for Multiple Hair Transplants by Using a Non-Surgical Hair Thinning Treatment
Preventing the Need for Multiple Hair Transplants by Using a Non-Surgical Hair Thinning Treatment

A gentleman has a large forehead that he thinks will not look good without a framing of hair. He wants to know if hair transplantation is a good option for him.

Dr. Amiya Prasad, a hair restoration specialist, explains that hair thinning or male pattern hair loss is a genetic pattern that has a variable age of onset based on family history. It is an ongoing process which means that for every patient who gets a hair transplant, there is an invariably a time where they need another transplant depending on the patient’s desire for hair density. Unfortunately, there is a mismatch between the amount of donor hairs available and the area that needs hair.

In Dr. Prasad’s practice, he has developed a method and treatment called Hair Regeneration. Hair Regeneration is the use of a material called extracellular matrix (ECM) combined with platelet-rich plasma (PRP) that's injected into the scalp to reverse hair thinning. It may sound too good to be true but he has over 5 years of data based on hundreds of patients who come to him from around the world to support its efficacy. As long as there is existing hair, there is a tremendous opportunity to reverse thinning and get density that far exceeds results of a hair transplant in most cases.

When someone comes to Dr. Prasad’s practice and wants a hair transplant, he first evaluates with a microscope and looks at the potential for hair growth and hair thickening from Hair Regeneration. He suggests doing the injection first and he looks at the results every 3 months all the way to 18 months until he can be 99.99% sure that he has reached the maximal potential. There are some people that he re-injects because they are more advanced and benefit from another injection. The amount of growth can be dramatic and he is always impressed by the response that his patients get. It seems to be a trend that the younger and earlier they come when hair loss is first noticed, the more volume they are able to achieve. He has treated people as young as 18 and as old as people who are 70. In fact, he even gets a lot of people with white hair have their hair grow back darker so there appears to be some benefit in reversal of hair grain.

This strategy may help this patient in planning out hair transplantation to frame his face so that has more hair and density. Dr. Prasad suggests learning more about Hair Regeneration and the medical treatments such as finasteride and minoxidil. He thinks this gentleman has more choices besides doing hair transplant which has been the standard approach for 30 plus years until he runs out of donor area.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Why FUE or FUT Hair Transplants Don't Prevent Hair Loss, and How to Stop Hair Loss
Why FUE or FUT Hair Transplants Don't Prevent Hair Loss, and How to Stop Hair Loss

A 19-year-old gentleman wants to know whether he should get and FUE or the strip method. He wants to know what method has better results and is less damaging to the donor area.

Dr. Amiya Prasad, a hair transplant specialist says that there is a greater yield of hairs in the strip method versus the FUE, and all hair transplant surgeons agree on this. FUEs are almost the way a hair transplant was done in 90s but now they’re just smaller punches. Another disadvantage of FUEs is that by design, surgeons have to go outside the area of genetically resistant hair to retrieve grafts. People are not getting the density that they want out of transplants, lose a lot of hair from transection or cutting of the grafts, and not getting the yield of grafts they were hoping for. This has already been proven by the International Society for Hair Restoration that 65% of hair transplant patients want more density.

As someone who has lost so much hair at a young age, this gentleman has to think about what he would look like if hair loss continues years from now. The hair transplant area is limited and therefore the donor area cannot meet the amount of hair needed to cover the scalp.

Currently in the United States, finasteride and minoxidil are the two drugs used for male pattern hair loss. Finasteride is a drug that is taken orally. It essentially affects DHT or dihydrotestosterone sensitive hair follicles. If hairs are DHT sensitive, they will respond to finasteride. However, many people are concerned about the long-term sexual side effects and dysfunction related to taking finasteride. In Dr. Prasad’s practice, most men who come in are not interested in taking finasteride. Topical minoxidil is not going to stop the progression of hair loss. It can prolong the appearance of thinning hair on the scalp so it looks like there is more hair, but it will not reverse hair thinning.

Dr. Prasad would offer Hair Regeneration first, a method and formulation he developed using a combination of extracellular matrix(ECM) and platelet-rich plasma (PRP) to stop and reverse hair thinning wherever there is existing hair. This is very different from what is currently the standard of care for hair loss. For most male pattern hair loss patients, they learn about hair transplant and then they look for the best possible transplant. However, it is important to understand that no matter how old someone is, a hair transplant is a limited and temporary solution because patients will progressively lose hair. Many people don’t even consider a transplant because they don’t want a pluggy look. A majority of hair transplant patients with obvious plugs used to have more hair, but the problem was that the hair thinned was lost, causing the transplanted hair plugs to become obvious.

In Dr. Prasad’s practice, he does a microscopic evaluation of the scalp and identifies the potential hair that can thicken from Hair Regeneration. He can determine how much they would benefit from Hair Regeneration. He had patients who are very advanced in their hair loss and he has been absolutely impressed by the amount of hair volume they have been able to achieve in spite of how far along they were. He believes strongly that as long as there is potential, there is opportunity to get improvement with Hair Regeneration. He is able to show the benefit of Hair Regeneration as outweighing the benefits of hair transplant in terms of volume of hair. His strategy is to do first Hair Regeneration even if they are a candidate for transplant, allow 18 months to transpire and then see where they are at. With this onetime treatment, the benefit lasts for at least 3 to 5 years. If they choose a transplant, they can be more strategic, efficient and effective with the grafts if they have the Hair Regeneration treatment first.

Dr. Prasad is very hesitant to transplant someone this young. He would rather do Hair Regeneration, wait it out, watch and see if there’s any progression and then consider a transplant if there's an appropriate understanding of what the limitations are.

For more information about hair loss, please visit our website: http://nyhairloss.com/
To learn more about Hair Regeneration, please visit: http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

To learn more about hair transplants combined with Hair Regeneration, go to:

http://nyhairloss.com/hair-restoration-by-dr-amiya-prasad/hair-transplantation/

To learn more about the limits of hair transplant surgery, go to:

http://nyhairloss.com/hair-restoration-by-dr-amiya-prasad/limitations-hair-transplants/

Deep Facial Lines Present After Dermal Fillers May Require a Limited Facelift
Deep Facial Lines Present After Dermal Fillers May Require a Limited Facelift

A 37-year-old woman is very concerned about her jowls and smile lines. She wants to know which is best for her between a facelift and fillers.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that jowls are the loss of definition of the jawline because of descent of skin and some fat. However, in this woman’s case he thinks that her jowls are relatively minimal. To determine if there is a significant amount of laxity of her skin that would justify a facelift, she can pull her skin back a little - if she sees a dramatic improvement, then she might want to consider this as an option. Dr. Prasad has been doing facelifts for over 20 years and in his practice, the youngest patient he has ever done a facelift on was 37-years-old. The patient and this woman have some similarities: both of them have a relatively thin face, and acknowledged that no matter how much filler placed on their mesolabial folds or the marionette lines, they weren't getting the correction they wanted.

Rare as it is, a facelift in a 37-year-old is done very differently than someone who’s in their 50s or older because it is not the same type of surgery. In someone who is younger, there isn't as much facial descent to deal with. The type of incision that this woman would have is usually limited. In Dr. Prasad’s practice, he hides it in the inside of the ear and try to follow the natural contours of the ears so it’s well camouflaged such that a woman can pull her hair back and not feel self-conscious. She still has to be prepared for a physical scar. Fortunately, Dr. Prasad uses in his practice not only optimal surgical techniques, but also a material called extracellular matrix and platelet-rich plasma (PRP). This is to optimize the wound healing process and to make the incisions as invisible as possible.

Dr. Prasad suggests that she meet with doctors to get opinions. She should get an understanding of how much descent and the desire to augment the relative lack of volume. If her choice is to give herself some fullness, then fillers such as Scupltra, hyaluronic acid fillers, Radiesse and PRP can all be done various ways to get the results that she desires. There are different areas of the face where these fillers can be appropriately applied.

From Dr. Prasad’s practice, this woman’s age would be the youngest that he has ever done a facelift for, but it is something that is possible. In terms of what effect it would have on her, that requires a professional opinion based on a physical examination. He suggests that she do a limited amount of a pull on her own. If she likes the result, then she must take the next step and travel as far as she needs to meet with a doctor that she is comfortable with. She can then move forward with the plan based on her understanding of the risks and benefits of doing lifting versus volume, or a combination of the two.

For more information about Face lifting surgery, please visit our website:

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

To learn more about injectables, please visit:

http://prasadcosmeticsurgery.com/injectables/

Addressing Loose and Draped Lower Eyelid Skin Mistaken for Puffy Eye Bags
Addressing Loose and Draped Lower Eyelid Skin Mistaken for Puffy Eye Bags

A 42-year-old female has hereditary bags under her eyes that make her look tired and aged. She wants to know what procedure she would get the most benefit from.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years and specializing in cosmetic surgery, assesses the puffiness under the eyes by looking at whether or not there’s fat under the eyes called orbital herniated fat. Herniated fat is the fat pockets that are behind the eyelid that pushes forward and creates a bulge - if that’s the case, he addresses the fat pockets. He also assesses the skin quality which has to do with: the thinness of the skin, the fine lines and wrinkles, and sun damage to the skin. He also looks at potential skin redundancy or skin excess. Lastly, he looks at the support structures of the lower eyelid which are very complex. The muscle under the eyelid called the orbicularis muscle acts like a hammock that holds the eyelid in place. It is attached to the bone by the lateral canthal tendon. He has seen patients from all over the world whose eyelids are pulled down or the eyelids are everted out which are caused by a compromise in the stability of the lower eyelid from cosmetic surgery. When he does an evaluation, he does the snap test where he pulls the eyelid down and sees how well it snaps back.

From this woman’s photograph, Dr. Prasad doesn’t see a lot of fat. Rather, it looks like the skin under her eyes is draping and folding downward. In the absence of a physical examination, she may just want to pull her eyelid up a little, not too aggressively, but just a bit to see if that improves the draping of the skin. If it does, she may need some kind of a procedure called a lateral canthoplasty or lateral tarsal strip - these are procedures where the lower eyelid is reinforced in terms of its support. Unfortunately, people think that the appearance of redundancy means there’s too much skin and they end up pulling the eyelid even further down.

Dr. Prasad thinks she is probably also a candidate for skin quality improvement. In his practice, he uses fractional CO2 laser for lighter skinned people. Fractional CO2 laser is a thermal device that ablates or removes the superficial layers of skin as well as generates thermal energy into the dermis to contract the skin and tighten it up. He combines this with the application of regenerative medicine in the form of platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood and is a concentration of the growth factors that are beneficial for wound healing as what was established in orthopedics and in oral surgery. He uses it in cosmetic surgery to help improve skin quality, blood supply, and to make the skin healthier from underneath. He works on the skin from both sides: on the outside with the laser, and from the inside with platelet-rich plasma. There is a good synergy in skin quality improvement in conjunction with lower eyelid surgery for better overall results.

Dr. Prasad suggests that she meet with qualified experienced cosmetic surgeons who specialize in eyelid surgery. It is no secret that doctors who tend to specialize have more consistent results in focused areas than those who don’t specialize. It’s just important to be comfortable that they are going to get the best result possible. At the same time, there is an art in doing procedures. Looking at before and after pictures, meeting with the doctor, having the examination, and feeling comfortable with this doctor’s style are very important. In Dr. Prasad’s practice, he does his procedures in his own Joint Commission-approved facilities. He has dedicated staff that the patient gets to know very well from the time of their appointment, to the time of their surgery and beyond. They feel more comfortable because they’re not having the experience of meeting new people like in a hospital or surgery center. He does the procedures under local anesthesia with LITE™ so that the recovery time is faster and most of patients go back to work in one week. All of that combined together to make a good experience.

For more information on lower eyelid surgery, go to:

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

For more information on fractional CO2 laser, go to:

http://prasadcosmeticsurgery.com/prasad-medi-spa/laser-light-treatments/microfractional-co2/

For more information on platelet-rich plasma (PRP) for cosmetic purposes, go to:

http://prasadcosmeticsurgery.com/injectables/platelet-rich-plasma/

The Limitations of Dermal Fillers to Treat Puffy Eye Bags, and Fast Recovery Eye Bag Removal Surgery
The Limitations of Dermal Fillers to Treat Puffy Eye Bags, and Fast Recovery Eye Bag Removal Surgery

A man is considering eye bag removal and fillers for his under eye puffiness and hollows. He wants to know what’s best for him.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, says that there is an increase in awareness of fillers to try to soften the appearance of under eye bags. Puffy eyes are caused by fat pockets under the eyes called extraconal fat or post septal fat. This fat is normally behind a structure called the septum. A combination of factors are associated with this condition including genetics, the thinning of the septum which results in the fat pushing forward, and the increase in volume that causes the bulges.

Traditionally, when someone has puffiness under their eyes that doesn’t get better regardless of sleep and other things associated with tired-looking eyes, Dr. Prasad generally recommends lower eyelid surgery. This is a definitive procedure and allows for a long-term correction of the anatomic issue of herniated fat moving forward. Unfortunately, many patients can’t do something definitive within the next 6 months to a year, but want this area to look better. This is where a discussion comes up as to what the expectations will be. Dr. Prasad tends to be very conservative. As a specialist in oculoplastic surgery, he gets to see a lot of patients who had too much filler placed and it made their eyes look puffier. These fillers are mostly placed by non-surgeons who can’t do surgery and want to help their patients, but become overzealous and put way too much filler. Their patients end up looking very swollen.

Judging by the photo, Dr. Prasad says that there is a bulge of fat in the outer aspect that is called the lateral fat pocket. If it’s bulging significantly, then chances are he’ll probably get more value and benefit in having the more definitive surgical procedure. This doesn’t understate the possible need to address volume adjacent to this area. There is always a science and art in doing cosmetic procedures.

In Dr. Prasad’s practice, he tries to soften the transition between the bulge and the adjacent trough or valley. He uses a filler like Restylane and often combines this with platelet-rich plasma. Platelet-rich plasma is derived from the patient’s own blood. When combined with Restylane, there is a very nice softening of this area that looks very natural. Often, people are very concerned about bumps and irregularities because these hyaluronic acid fillers tend to have a gel-like quality that makes them quite thick. However, when combined with platelet-rich plasma (PRP), it seems to work with the skin and integrates the material in a way to soften the area. In addition, the benefits of platelet-rich plasma include generation of collagen, improvement in skin quality and blood supply.

Unfortunately, beyond a certain threshold, there is no value to fillers. People try to hold off having surgery and they keep on going for fillers. When people come to Dr. Prasad and he shows them examples of his before and after patients and how they look like in a week, they are often surprised. Within a week, many of his patients after lower eyelid surgery have less swelling and bruising compared to patients who had injections with fillers. The other concern is the way the surgery is done. When Dr. Prasad does lower eyelid surgery, he doesn’t use general anesthesia so patients are less afraid of going under a respirator and having invasive surgery. He does the procedures in his office under local anesthesia with LITE™ sedation. It’s like the injectable experience even though it is real surgery.

Dr. Prasad thinks that he should meet with experienced cosmetic surgeons who specialize in the area. This is an area that’s very delicate and he thinks he should go to doctors who really work in this area a lot and have both the skills to do the surgery as well as the skills to do the injectables. He must figure out a plan that works for him.

For more information on lower eyelid surgery, go to:

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

For more information on transconjunctival blepharoplasty, go to:

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

Why Changing Natural Asian Double Eyelids into a Caucasian Shape is Not Possible or Advised
Why Changing Natural Asian Double Eyelids into a Caucasian Shape is Not Possible or Advised

A Burmese girl naturally has a double eyelid. However, she wants more Caucasian-looking eyes. She wonders if it is possible for her to get Caucasian eyes with an eyelid procedure.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon with a specialty focused in Asian eyelid surgery, says that he rarely hears a patient who wants Caucasian eyes. In fact, most people come to him and say that they don’t want a look Caucasian, they just want a nice, defined crease.

People with Asian descent have a distinct shape of soft tissue and bone structure of the eyes. They also have genetic elements that make up their unique ethnic background. When someone tries to make someone look different from their original race or original ethnicity, they risk crossing a line of looking unnatural. There are many people in the media like actors and musicians who tried to do more than just enhancement and they became symbols of bad plastic surgery.

Dr. Prasad’s first suggestion to this girl is to explore why she wants to look more Caucasian. It is important that she feels comfortable with her ethnic identity before she undergoes an aesthetic procedure. It is standard in Dr. Prasad’s practice and in his profession to try to establish realistic expectations for any patient who considers a cosmetic procedure. Cosmetic procedures enhance someone’s life, but it doesn’t necessarily change their life. It may change how they look at life, it may make someone feel more confident, but it doesn’t make someone who is Asian be mistaken for someone who is Caucasian.

In the United States and practicing in New York, Dr. Prasad has seen an amazing blending of ethnicities. People who have one Asian parent and a non-Asian parent have offspring with remarkable ethnic blending. In that respect, it still looks natural because it is by design from the beginning. He would just emphasize not to pursue aggressively this type of change unless someone has a realistic understanding of what the outcome will be. Certainly they can get a deeper crease or do some other things that are not outside of eyelid surgery. Some people would get augmentation of the nose to build a more defined bridge or do other things that are more extensive on the face. He says it is simply not possible to make some of Asian descent make them look like they’re Caucasian. Rather, they should embrace their ethnicity if they want to do some kind of enhancement. Most importantly, they should discuss this with people who are close to them to establish what their motivation is to change their appearance.

For more information about Asian eyelid surgery, please visit our website:

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

How to Improve Appearance of the Forehead Area with Upper Eyelid Surgery and Botox Treatment
How to Improve Appearance of the Forehead Area with Upper Eyelid Surgery and Botox Treatment

A 43-year-old woman has deep forehead wrinkles, loss of volume, crow’s feet and droopy eyelids. She is scared of surgery but if recommended, would definitely consider it.

Dr. Amiya Prasad, an oculofacial plastic surgeon, starts by first letting his patients understand why someone looks older than they are. Mostly, it is caused by genetics such as lighter skin people with light colored eyes often tend to have fine lines and wrinkles earlier than people with darker skin. This has to do with the dermis which is the backbone of the skin and people of African descent tend to have a very thick quality of the skin. He also asks things that may contribute to the aging process such as whether or not they smoke, if they’ve been through a lot of stress and their diet. Healthy aging does require healthy lifestyle. Proper sleep, good diet and exercise are critically important because no matter what surgeons do in the cosmetic surgery, they cannot help somebody to their full potential if they have toxic influences in their life.

In Dr. Prasad’s practice, he does a lot of eyelids and facelifts. He recalls a patient of his who was a long term smoker and she wanted to have a facelift. He told her that he wasn’t going to do a facelift unless she quit smoking. This is because the healing process is going to be negatively impacted by smoking. She did stop smoking and she chose a very holistic and healthy lifestyle. To prove it, Dr. Prasad actually did serum nicotine tests to ensure that. Within a few months, her skin looked vibrant, she looked really healthy and she felt fantastic.

Dr. Prasad can tell that it’s her mid to upper face that bothers her. She has some hooding of her upper eyelids and she also has horizontal lines on her forehead. Hooding of the eyes is caused by the increase in skin volume due to stretching as well as the brows may be slightly descending. She may unconsciously raise her eyebrows to be able to see well and to relieve your eyelids of that physical weight causing the horizontal lines on her forehead. It’s a typical unconscious habit.

In cases like this, Dr. Prasad would do an upper eyelid blepharoplasty to relieve the hooding on the eyes and to improve the appearance. Their eyes look brighter because eyes that are very hooded look very tired and it creates the look of aging. Concurrently, he will do a little botox in their forehead to relax the horizontal lines. That helps extinguish the habit. Even after the upper eyelid blepharoplasty, a lot of people will persist in raising their eyebrow because they have built up this habit. When a surgeon botox that area, the brows are in a better position and they don’t have the horizontal line.

Dr. Prasad thinks it might be worth considering an upper eyelid blepharoplasty to help her with this upper face rejuvenation. She has explored non-surgical options but for the level of hooding that she is experiencing, she’ snot going to get that much of an improvement with any of the radiofrequency devices or any other of the non-surgical options. She should consider upper eyelid blepharoplasty, think of the lifestyle changes that might be contributing to her appearance and discuss this with the doctors she has been visiting.

For more information about upper eyelid surgery, please visit our website:
http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/

To learn more about injectables, please visit:
http://prasadcosmeticsurgery.com/injectables/

Thinning Hair Treatment that Can Prevent Hair Loss and Replace a Hair Transplant
Thinning Hair Treatment that Can Prevent Hair Loss and Replace a Hair Transplant

A 26-year old gentleman has diffuse hair loss. He wants to know if there is hope to restore his hair.

Dr. Amiya Prasad, a hair transplant specialist, explains that when someone with hair loss comes to his practice, he first asks the age of onset or how old was the patient when he started losing hair. He also asks how quickly this is progressing and if there are other male family members who have similar patterns or hair loss. In male pattern hair loss, there is progressive miniaturizing of hair. Hair normally grows in a cycle and at the end of every cycle, it sheds. When the new hairs come in, they come back thinner. Dr. Prasad would typically assess the top of the scalp with a microscope to identify the amount of hairs that are thinning relative to the amount of hairs that are still thick.

There are two medical options to treat hair loss. Finasteride is a drug that inhibits an enzyme called 5-alpha reductase that is responsible for the conversion of testosterone to dihydrotestosterone (DHT). Hairs that are sensitive to dihydrotestosterone will progressively thin and go away. When someone has that type of hair loss takes finasteride, it slows that progression and can allow them to have thicker hair for a long period of time. Unfortunately, medical studies have shown possible long-term sexual side effects of taking finasteride. In addition, literature does not provide enough information about all the factors that cause hair thinning because dihydrotestosterone is not the whole story. Many men will take finasteride and still progressively lose hair. The other drug is minoxidil. Minoxidil is applied topically and appears to keep hair around longer so that it appears that the scalp has more coverage. However, it does not reverse hair thinning.

For a patient like this gentleman, Dr. Prasad doesn’t go for hair transplant first. This is a significant change in the paradigm of how to treat hair loss. The standard approach before is to do a hair transplant, but the patient still continuously loses hair. Many patients will opt to do another hair transplant and another one every few years until they reach the end of the donor area. Unfortunately, there’s a mismatch between the amount of hair that they have in donor and the amount of scalp they need covered. Eventually, people will have plugs on their scalp which shows an obvious hair transplant.

In Dr. Prasad’s practice, he has developed a non-surgical treatment called Hair Regeneration. A material for wound healing called extracellular matrix that is used to help regenerate tissue and skin by recruiting adult stem cells can be used for hair restoration. When this material is injected in a formulation combined with platelet-rich plasma, it is remarkable in how effectively it can reverse hair thinning. Dr. Prasad had hundreds of patients who come from all over the world and every week, he sees more and more patients for this treatment as he continues to prove its benefit. It appears to have a minimum 3 to 5 years of benefit. The younger the patient is and the more coarse the hair is, it appears that they get remarkably more volume and correction, so early intervention is important. When someone notices hair loss, the earlier they come, the better it is. In most patients who have existing hair, it far exceeds the benefits of any hair transplant.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

After Extreme Weight Loss, Face Lifting Procedures Restore Accelerated Facial Aging and Sagging
After Extreme Weight Loss, Face Lifting Procedures Restore Accelerated Facial Aging and Sagging

A 45-year-old woman has lost 490 pounds through diet and exercise. Unfortunately, she was left with facial sagging and excess skin, but is unhappy with fillers she had applied for facial volume correction and enhancement. She wants to know the appropriate procedure to correct her face.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that this woman’s situation is becoming more common as people have significant weight loss in this country. Whether it’s from bariatric surgery, gastric banding or various other procedures, there’s actually a separate specialty of doctors who perform surgery on the body to restore people’s appearance after all that excess skin remain after the weight loss. On the face, there can be various levels of excess skin. It is normal to have a certain amount of facial volume loss, sagging and descent associated with facial aging. However, in a case of someone who had significant obesity, they also have to think of the physical impact on the whole body. It’s no secret that obesity does have aging effects on the body. This is the basis for so many medical issues in this country whether it’s cardiac disease, diabetes and several osteoarthritis or orthopedic issues.

The basic principle of dealing with the aging process is deciding the dominating factors. One should know if it is volume loss consisting of bone, muscle, fat and soft tissue, or descent which is sagging of the skin and the supporting structure of the skin. If the face was very inflated, then ligaments and all supporting structures got stretched. As someone lost weight, they lost a lot of integrity of those structural aspects. When a patient comes to Dr. Prasad’s office, the first that he does is a limited lift to see if the skin has room to move and then he discusses that option and looks at the result.

Dr. Prasad’s preference for someone who has facial aging changes and has significant descent and sagging is to have volume corrected after restoration of the proper anatomy, whether through a facelift, or a face and necklift, or a combination of facelift with cheek implants. Fillers tend to get lost when skin is sagging. Filler placement is about strategy, not about absolute volume. There’s an upper limit of how much volume the skin and soft tissue can take before it starts to look amorphous. In Long Island where Dr. Prasad holds his practice, he sees a lot of people with "pillow faces" which doesn’t look natural.

Dr. Prasad suggests that this woman should start meeting with cosmetic surgeons and discuss options. A surgeon would have a more unbiased opinion because they can offer both the surgery and the non-surgical options. If someone doesn’t have that much sagging and descent, volumetric filling with the use of a filler like Sculptra can be beneficial. A lot of people who have had weight loss will use a filler like Sculptra because when it is injected, it stimulates collagen and is very effective for diffuse filling of the face. Sculptra was originally developed to help people with HIV lipodystrophy or people who are HIV positive on medication that resulted in facial fat volume loss making them look very hollow. By using Sculptra, this material expanded and helped give diffuse volume. Sculptra can last up to a year or longer. There are a lot of different options between lifting and filling. It really requires a more customized approach based on physical examination.

For more information about Face lifting surgery, please visit our website:

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

To learn more about injectables for volume correction and regenerative healing, please visit:

http://prasadcosmeticsurgery.com/injectables/

Why People with Negative Vector Need a Specialist for Eye Bag Removal Surgery
Why People with Negative Vector Need a Specialist for Eye Bag Removal Surgery

A 40-year-old woman says she has negative eye vectors, eye bags, and deep-creased dimples on her cheekbones. She wants to correct the bags under her eyes that always make her look tired even when she is not.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon who specializes in facial rejuvenation and complex eyelid surgery has been practicing in Manhattan and Long Island for over 20 years. He says that with the absence of a physical examination, that this woman appears to have lower eyelid fat prolapse. Lower eyelid prolapse means that the fat that is normally around the eyes pushes forward like a hernia creating these bags. Regardless of how much sleep she gets she is still going to have the bags underneath her eyes and so they need to be addressed.

When Dr. Prasad does an examination of the lower eyelids, he looks at several factors: presence and the degree of fat prolapse, skin quality, skin quantity as well as the integrity of the support of the lower eyelid. In addition, a negative vector is a very important factor in determining the optimal solution for lower eyelid surgery. People with negative vectors are at a higher risk for complications such as eyelid retraction, ectropion, or rounding/ scleral show of the lower eyelids because of the physics of the procedure and the way the body heals after the procedure.

For this woman, Dr. Prasad would perform a transconjunctival lower eyelid blepharoplasty to address the fat pockets. This is a procedure where the fat pockets are addressed from the inside of the eyelid in combination with the resection or removal and repositioning to optimize the shape and contour so it looks like the patient never had the bags under her eyes.

Dr. Prasad also routinely addresses skin quality with the combination of laser or radiofrequency depending on the skin type. Thermal energy does have a value if skin needs collagen. If there is more skin such as redundant skin, then he addresses it with a skin pinch or something similar at the eyelid margin. The other thing that he does is he uses platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood and it contains growth factors that help improve skin quality, dark circles, discolorations and the backbone and structure of the skin. No laser has ever achieved that type of result. It is suited for all skin types such as patients with darker and lighter skin. Addressing the fat pockets and improving skin quality will make a real difference for the appearance of under eye bags.

At this point, Dr. Prasad thinks this woman is ready to meet with qualified, experienced cosmetic surgeons. He has a bias towards specialists in eyelid surgery because of the unique perspective that they have and this area is this very delicate and deceptively complex area. Eyelid surgery is one of the top 5 most popular cosmetic procedures. He would estimate, as a specialist who gets to repair a lot of undesirable results, that up to 20% of people who have undergone eyelid surgery would have some type of issue that needs unique management or advanced care after surgery. So she should meet with doctors who can show her before and afters where she feels comfortable with their results and style. This is not just technical expertise but style and the type of results that she is looking for. In addition, also the type of anesthesia and the amount of experience are also very important for her to be comfortable. For example in Dr. Prasad’s practice, he does his procedures under local anesthesia with LITE™ IV sedation in his facility. His patients get to know his medical staff and feel comfortable from the day they come to his practice. Technical expertise, artistry of the doctor, the support staff that helps the doctor, the type of anesthesia and the aftercare all combine to maximize the results of the procedure.

For more information about eyelid surgery, please visit our website:

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

For more information on transconjunctival blepharoplasty, go to:
http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/

Determining Most Appropriate Type of Asian Double Eyelid Surgery Based on Individual Anatomy
Determining Most Appropriate Type of Asian Double Eyelid Surgery Based on Individual Anatomy

A woman has been contemplating of getting Asian eyelid surgery to create an upper eyelid fold. She wants to know the best procedures to make her eyes look larger and attractive-looking.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon specializing in eyelid surgery, says that Asian eyelid surgery has been an area of focus in his practice for over 20 years. 50% of people of Asian descent have a defined eyelid crease, and 50% do not. There’s a lot of emphasis on having big eyes and this is not necessarily to look Caucasian or non-Asian, but to look as if a person naturally has an eyelid crease that creates an illusion of the eyes looking more open. When he sets out to do eyelid surgery, he always tries to perform the procedure in a way as if the person was born with that natural crease. Unfortunately, there are a lot of people who don’t want that and want a more exaggerated appearance: either they want a very high and deep crease, or they want the eyelids to look wider and look as if they were born in a different way.

In Dr. Prasad’s practice, when he looks at a patient who has interest in Asian eyelid surgery, he does something simple by using a Q-tip to create a little fold. He looks at how the eyelid crease forms naturally. If they have a very strong epicanthal fold, the crease tends to fold naturally into the epicanthal fold. If it’s a softer epicanthal fold, then the crease goes above it or parallel. In terms of the outer aspect of the eyelid, it tends to taper outward in a parallel manner which his patients appreciate.

There are different types of Asian eyelid surgery. In the incisional approach, an incision is made to create a connection. When a surgeon does the incisional or the non-incisional approach, the idea is to create a connection between the skin and a muscle called the levator muscle. With the excisional procedure, some skin and fat are removed to create a connection between the eyelid skin and the levator muscle. In the non-incisional procedure, little openings are made which are technically incisions, but instead of a long incision, several dots are strategically placed on the eyelid. Those little openings are used to pass a suture to engage the eyelid skin to the levator muscle without any stitches on the outside to create a crease.

To make the differentiation of who is a candidate for the procedure, Dr. Prasad basically looks at whether or not there’s extra skin, how cooperative the skin is when making the fold, and whether or not there is a presence or absence of extra fat that might need to be addressed in order to establish a fold. Both procedures have their pros and cons and each procedure has its risks and benefits. Dr. Prasad generally finds that younger people with thinner skin which folds easily are best suited for the non-incisional procedure. Someone who’s older tends to have a little extra skin. If someone has much thicker skin and fat behind and it doesn’t fold very easily, then he recommends the incisional procedure.

As far as other procedures that are related such as extension of the lateral canthus or addressing the epicanthal fold, it is called epicanthoplasty. Dr. Prasad generally doesn’t recommend those procedures except in cases where the epicanthal fold is so wide and prominent that it actually makes the person look like they’re cross-eyed. Generally, what he tries to do is to create a natural crease that either tapers into the epicanthal fold, or a little deeper and higher to create a wider eyelid platform and deeper crease.

A lot of people have come to Dr. Prasad who use eyelid tape. This tape can be applied right above the eyelashes to create a fold. These patients have brought the tape in to show him exactly where they want their crease. Most of the time, he is actually able to use the tape to mark off where he is going to place the stitches in order to create the crease they desire.

Dr. Prasad suggests that this woman meet with different doctors who specialize in Asian eyelid surgery and learn more about the options, and figure out what they’re comfortable with. Once she has met with qualified experienced surgeons, she should make the decision with the doctor she feels comfortable with and move forward.

For more information about Asian eyelid surgery, please visit our website:

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

Treating Puffy Eye Bags, Wrinkles around the Eyes, Dark Circles, and Hooded Eyes Separately
Treating Puffy Eye Bags, Wrinkles around the Eyes, Dark Circles, and Hooded Eyes Separately

A 39-year-old woman has had depressions under her eyes for as long as she can remember. She is asking for suggestions for what she can do about them

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, says that there are few things that she should look at besides looking at the close-up of her eyes. He also does a lot of facelifts so he looks at the eyes from not only the perspective as a specialist in eyes but also as a specialist in facial rejuvenation. Since she is bothered by the appearance of her eyes, sometimes she gets so focused in this area that she misses the details of the rest of the face that contribute to the overall appearance. When Dr. Prasad looks at someone’s eyes, he looks at the mid face which is also called the submalar or the cheek area. He also looks at the eyelid-cheek junction because not only will she see puffiness under the eyes, but she will also see volume loss in the cheek area.

This woman’s upper eyelids appear to have some extra skin and some fine wrinkling, while the lower eyelids appear to have some puffiness and fine wrinkling of the skin. There is more wrinkling when there is muscle activity such as smiling.

In Dr. Prasad’s practice, it is routine to perform an upper eyelid blepharoplasty to reduce the excess skin and sometimes sculpt the fat that’s underneath the eyelid skin, the orbital fat and the sub-brow fat. He also does a nice closure to minimize the upper eyelid incision to allow for a natural appearance and rejuvenation. Hooded upper eyelids tend to make people look sad and tired as it dominates the intrinsic natural shape of the eyes.

This woman’s lower eyelids have lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that’s normally around the eyes has pushed forward like a hernia and creates puffiness. When there is a relative depression, the volume adjacent to it makes the depression look deeper. Dr. Prasad suggests performing lower eyelid blepharoplasty. There are two ways to do a lower eyelid blepharoplasty: one is from the outside called a transcutaneous blepharoplasty which means making an incision underneath the eyelashes, the other is a transconjunctival blepharoplasty which is from the inside of the eyelids. From Dr. Prasad’s personal experience, he likes doing the transconjunctival blepharoplasty because it tends to retain the natural shape of the eye. It allows for preservation of the lower eyelid support structure such as the orbicularis oculi muscle and the tendons. The lower eyelids are deceptively complex because there are several key structures that are necessary for the balance of the lower eyelid to retain a nice eye shape. Often, people have lower eyelid retraction or ectropion where the eyelid everts away and they come for revision surgery.

When patients have fine lines and wrinkles, Dr. Prasad does two methods. One is fractional CO2 laser that combines an ablation or removal of the top layer of the skin as well as generation of the top layer of the skin. It also generates thermal energy into the dermis or the backbone of the skin to create tightening. He also uses regenerative medicine technology called platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood which is basically the same technology applied in orthopedics for joints and wound healing. It is applied to the skin to stimulate new collagen, blood supply and improvement of skin quality.

During Dr. Prasad’s consultations, he always points out to his patients about potential hollowing after this type of surgery. It’s not caused by taking too much fat under the eyes but about the presence of volume loss in the cheeks due to facial aging. Volume loss cannot be addressed in eyelid surgery. He suggests procedures such as fat transfer, submalar implant or an injectable such as Radiesse, Restylane or any hyaluronic acid fillers to balance them out.

Dr. Prasad suggests that she meet with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery. He really strongly believes in extensive experience in any area in cosmetic surgery because it allows patients to have a more predictable result. When a doctor has experience in a specialization, then it’s a matter of matching the patient’s aesthetics and the surgeon’s aesthetics to get the desired results.

For more information on transconjunctival blepharoplasty, go to:

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

For more information about upper eyelid surgery, go to:
http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/upper-eyelift-surgery/

For more information on platelet-rich plasma, go to:
http://prasadcosmeticsurgery.com/injectables/platelet-rich-plasma/

For more information on hyaluronic acid fillers, go to:

http://prasadcosmeticsurgery.com/injectables/restylane-perlane/

Why Congenital Ptosis May Require More than One Ptosis Correction Surgery in a Lifetime
Why Congenital Ptosis May Require More than One Ptosis Correction Surgery in a Lifetime

A man has had ptosis since birth but did not have surgery until he was 4 or 5-years-old, but his eyelids are continuously drooping. He wants to know the procedures to correct this, the cost of the surgery, and if insurance will cover it.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that congenital ptosis is a condition wherein the muscle that lifts the eyelid called the levator muscle did not develop fully during gestation. It tends to run in families but is expressed differently in several siblings. The levator muscle can either be mildly to severely affected in terms of the level. The actual activity of the muscle ranges from fully functional to very weak. When he does a ptosis examination, he looks at a patient, sees their eyelid level, and how much the eyelid blocks their pupil. He asks them to look down and up to establish how much muscle function they have. From an ophthalmologic point of view or from the point of view of eye health, he also wants to look at conditions such as dry eyes and Bell’s phenomenon. This phenomenon is a protective mechanism to make sure that the eye rolls a little so that when someone is sleeping, even if their eyes open a bit, they’re still protected.

In choosing the type of surgery, patients are divided into those with good enough muscle function versus those who have no muscle function. Dr. Prasad typically does a levator muscle resection for those with good enough muscle function, which is shortening the muscle so that the eyelid can come up. When the muscle is shortened, the eyelid will open but it will not relax and close the exact same way as the other eye. In addition, patients need to add lubrication to the eyes as part of the post-operative care for the long-term.

For patients who have congenital ptosis, it is not surprising for them to have more than 3 operations in their lifetime: one in childhood for visual development, another one at adolescence to early adulthood for aesthetics, and one later in life for functional and aesthetic reasons because the tissue stretches and the facial aging process goes on.

Another type of ptosis is levator muscle dehiscence or aponeurotic ptosis. This is normal age-related attenuation or thinning of the muscle that causes the eyelid to droop. Patients may be dealing with that in the other eye and so an examination has to be established whether or not there’s any merit to addressing the other eye at the same time. Dr. Prasad tests for Hering’s Law where he lifts the droopier eyelid and very often, the other eyelid will actually descend. It has to do with amount of signal that is generated by the brain to push the eyelid open.

The other option aside from levator resection is a procedure called a frontalis sling. This is done routinely in younger children but when it is done for an adult, there is a challenge. However, when this procedure is done in adults, one eye is always open because the frontalis muscle has to be forced to function to effectively to open the other eyelid. It takes a long time for an adult to acclimate this function.

In terms of the cost of this procedure, patients have to see if the doctor they choose accepts insurance and is willing to go through the process of insurance approval. The problem with the modern world and why over 10 years ago Dr. Prasad stopped accepting any kind of medical insurance is that insurance companies are openly deceptive in their practices. They will approve a procedure and then later on deny the procedure. Or they will go back and audit doctors and say their procedures are not indicated and ask for refunds. Dr. Prasad has seen how very deserving patients whose eyes are completely closed are denied by insurance companies. This man is going to have to try and find a doctor that either accepts insurance and is willing to go through the process, or find a doctor he can afford. Cost is a factor and the procedure does require the: surgeon's fee, anesthesia and facility costs which are all part of delivering high quality care.

Dr. Prasad suggests meeting with doctors, most likely oculofacial or oculoplastic surgeons who have extensive experience in this area. Most general plastic surgeons are not trained in this area and don’t really practice this so he’s not likely find too many who are willing to do this type of surgery. He should meet with doctors he is comfortable with and figure out what options he wants.

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

How to Get Rid of Puffy Eye Bags, and Factors that Can Make Swelling Under Eyes Worse
How to Get Rid of Puffy Eye Bags, and Factors that Can Make Swelling Under Eyes Worse

A 24-year-old gentleman has darkening and swelling bags under his eyes, but also has post nasal drip and suffers from insomnia which may be contributing to them. He is looking for advice on the best way to treat his baggy eyes.

Dr. Amiya Prasad, an oculofacial plastic surgeon says that this gentleman appears to have puffiness under the eyes. If it’s constant, then this puffiness represents lower eyelid fat prolapse. Lower eyelid fat prolapse is when fat that is normally around the eyes pushes forward and creates a bulge.

The eye area happens to share a zone of drainage which is also associated with the sinuses. If someone has issues with sinuses such as sinus problems and allergies then the puffiness can actually look more significant and can fluctuate. They can have good days or days where they look puffier.

Irregular sleep is a form of stress. When people ask Dr. Prasad what they can do to help maintain the appearance of their eyes after they had their cosmetic procedure, he always reminds them that they should avoid stress. For example, a typical American president looks very different from the first day before the inauguration and 4 years later. Their eyes look very tired. The eyelids are the most sensitive, and thinnest skin in the body, and the tissue is very delicate. Stress to the body whether it’s physical, lack of sleep, sinus or allergies can affect the eyes.

In terms of the fat prolapse, Dr. Prasad recommends lower eyelid blepharoplasty which is approaching and sculpting the fat pockets. In his practice, he prefers the transconjunctival approach which is from behind the eyelid to reduce the puffiness. That takes away enough of the negative of the appearance but it is very important to try to work on the lifestyle and address the issues with the sinuses and the allergies.

In terms of lower eyelid transconjunctival blepharoplasty, Dr. Prasad routinely performs this procedure under local anesthesia with minimal IV sedation so that his patients can recover quickly and it doesn’t disrupt their work schedule. He thinks it’s important that this gentleman move forward with meeting with doctors, possibly with allergists, ear-nose-throat doctors as well as qualified experienced cosmetic surgeons to get some opinions on what he can to do to look less tired.

For more information on lower eyelid surgery, go to:

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

For more information on transconjunctival blepharoplasty, go to:

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

How to Get a Defined Jawline and Solve a Double Chin Surgically and Non-Surgically
How to Get a Defined Jawline and Solve a Double Chin Surgically and Non-Surgically

A man with a double chin is confused whether he should consider a chin implant or a necklift to have a more defined jawline.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, has a lot of experience doing facelifts, neck lifts and neck liposuctions and even facial implants including chin and submalar cheek implants.

A necklift is a procedure with an incision that is made slightly in front and behind of the ear to lift excess, redundant and sagging skin, and to also deal with platysmal bands. The muscle that is underneath the skin contributes to the appearance of bands and sagging skin, so a necklift is a procedure for that type of situation. Dr. Prasad would first evaluate and see if the patient has extra skin or if it is a manifestation of other anatomic issues related to the hyoid bone. The hyoid bone defines the neck angle. For some people, it’s low and forward or high and back. The hyoid bone is important in determining whether or not a lift will help. If the hyoid bone is very low or it’s very forward, then there may be a very short distance between the bone and the chin. When the surgeon pulls up the skin, the patient will not get much of a differentiation. This is important for people dealing with facial aging because there is a downward decent of migration of the hyoid bone. In a consultation, Dr. Prasad typically lifts the skin to show the patient their maximal potential benefit.

The choice of a chin implant or to add projection to the chin is also not straightforward procedure. The chin is back maybe because it is relatively short or there is a misalignment in the position of the mandible, or the jawbone relative to the upper jawbone composed of the mandible and the maxilla. Sometimes, people have the perception of a weak chin because their teeth are relatively misaligned. By doing a simple examination in the mouth, doctors can see if someone has a relative overbite and the chin is posterior. If that’s the case, if they were to get a chin implant, they would get deepening of an area called the labial-mental crease between the lip and the chin. In some people, it can be adjusted and the chin implant can be positioned. Patients should choose a size that would fit the face if they’re not interested in doing some kind of oral-maxilla type of procedure.

In this man’s situation, Dr. Prasad says he might be a candidate for a chin implant and may also consider neck liposuction. This procedure reduces fat along the under part of the jawline as well as below the chin if there’s extra fat. However, he has to be conscious of not taking too much fat away. Most of the time, plastic surgeons are very aggressive about removing fat. Dr. Prasad has had patients who needed to get fat transfer to restore the fat or he did something to rehabilitate the skin. The thin layer of fat under the skin makes skin look youthful. Last issue is the physical weight. If a younger person is over 10 pounds their ideal body weight, then a simple weight loss can actually help define the jawline and the neck.

Dr. Prasad suggests that this man have a physical examination with qualified experienced cosmetic surgeons and explore his options. The photo is helpful but to make a recommendation that is definitive would require an examination. Anatomic features such as the position of the hyoid bone, physical weight, the position of the mandible relative to the maxilla in terms of his bite, or if he has an under bite or a normal bite are all factors to consider before making this decision.

For more information about neck lifting surgery, please visit our website:
http://prasadcosmeticsurgery.com/prasad-face-eyes/facial-surgery/necklift-rejuvenation/

To learn more about facial implants, please visit this website:
http://prasadcosmeticsurgery.com/prasad-face-eyes/facial-surgery/facial-implants/

How to Prevent Further Hair Loss with a Non-Surgical Hair Transplant Alternative
How to Prevent Further Hair Loss with a Non-Surgical Hair Transplant Alternative

A gentleman has hair loss and automatically thinks the only solution is a hair transplant, and asks how many grafts he would need.

Dr. Amiya Prasad, a hair transplant specialist, says that this gentleman has male pattern hair loss. During evaluation, he determines the age of onset or how old was the patient when he started losing hair. He also asks about family history or if there are family members with a similar pattern so that he can get an idea of what the rate of progression is. Hair loss is not a single event, but a process of hair thinning eventually leading to hair loss. This is an important factor to think about when someone is thinking about surgical hair restoration.

Dr. Prasad also asks about the medications that a patient is taking. In the United States, there are two FDA-approved drugs for hair loss in men, with one being finasteride which is a pill taken daily. Finasteride works by inhibiting an enzyme called 5-alpha reductase. This is the enzyme that converts testosterone to dihydrotestosterone (DHT). DHT is responsible for causing thinning for DHT-sensitive hair follicles. If the DHT is diminished, the triggering factor that causes the hair to thin is also diminished. Minoxidil is the other drug that is used topically which prolongs the hair growth cycle so that patients appear to have more hair in the scalp. Currently, there is a lot of concern about finasteride and its sexual side effects.

Before considering a hair transplant, patients must understand that they don’t stop losing hair especially if they are not able to take any medication like finasteride. Regardless of the number of grafts that are placed, they’ll continue to lose hair. Another thing to consider is that patients only have a limited area to transplant hair from. Currently, it’s very popular to look at follicular unit extractions as “scar-less surgery”. However, in order to do follicular unit extractions, surgeons have to go way outside of the true donor area or the genetically resistant area where hair is taken for a hair transplant. Unfortunately, this area only has limited number of hairs available and is not enough to cover a lot of area in the bare scalp. Patients also need a lot of hairs to achieve density. During a hair transplant, surgeons have to place grafts as close as possible and a certain amount of hairs will not survive. They would need more than one transplant to fill in those corners to get the volume that they want in the face of progressing hair loss.

In Dr. Prasad’s practice, he has developed a non-surgical method of restoring hair called Hair Regeneration. In male pattern hair loss, the hair is going through progressive hair loss, but with a microscope, he can see a lot of potential hair. In Hair Regeneration, he uses extracellular matrix which was originally used for wound healing and is combined with platelet-rich plasma (PRP) derived from the patient’s own blood. Through a formulation and method of technique of delivery, it treats the thinning hair and reverses hair thinning so that hairs become thicker. He has hundreds of patients to prove the validity of this procedure. He has been able to demonstrate that this exceeds the results of almost any transplant. For younger people, without surgery, they can have an injection that results in significant correction of volume and area of coverage and halting hair thinning progression.

When a patient comes to Dr. Prasad’s practice asking for hair transplant, he first discusses the number of grafts and look at the area of hair loss to estimate the number of grafts that they would need to fulfill that requirement. However, before doing the surgery, he would insist that they would first do the Hair Regeneration procedure so that they would benefit from the reversal of hair thinning and thickening of the existing hairs. At the end of 18 months, they get the full benefit. If they want more hair, then Dr. Prasad can be more secure in the strategy of doing a transplant because he knows that the patient’s progression of hair loss would not be continuing. He can also be more strategic in the way he is able to place the hairs.

The typical approach is letting patients understand their limitations and avoiding surgery because they might end up having a short-term benefit. With surgery amidst the progressive thinning, they might end up having only the grafts left. That’s why a lot of people are dissatisfied with hair transplant results. Hair Regeneration has become the treatment of choice for people who are thinning and have existing hair before moving on to hair transplant. Fortunately, more than 90% of Dr. Prasad’s Hair Regenration patients feel they don't need a hair transplant.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:
http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Importance of Diagnosing Drooping Eyelid Cause before Undergoing Ptosis Repair Surgery
Importance of Diagnosing Drooping Eyelid Cause before Undergoing Ptosis Repair Surgery

A 25-year-old lady has a drooping eyelid which has been progressively becoming worse. Her family doesn’t recognize the difference. She wants to know if this is normal and the procedures that can help her eyelid.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years, has a background in eye surgery and plastic surgery of the eyes and face. Ptosis is something he deals a lot with in his practice. Most people have a difference of about 1-2 millimeters between the two eyes, which is why her family is not acknowledging an obvious difference. At the same time, when she takes photos or when she gets tired, a lot of those differences are obvious.

During evaluation, Dr. Prasad would ask patients to look at previous photos. There’s a condition called congenital ptosis which is when one or both eyes are drooping because of the development during gestation of a muscle that lifts the eyelid called the levator muscle. Someone may have symptoms of drooping eyelids that causes the eyelid to progress a little lower but they may also have some degree of drooping eyelid throughout their lives. In addition, any kind of trauma that causes the eyelid to swell can make it droop because of eyelid stretching. If that’s not the case, then he wants to also rule out any neurological causes, so an examination with an ophthalmologist, neuro-ophthalmologist or neurologist is needed to ensure the eyelid drooping is not a sign or symptom of something else that may need intervention other than surgery.

Normally, people have drooping eyelids as they get older because the tendon of the levator muscle called the aponeurosis tends to get thinner and detaches. This phenomenon is called involutional ptosis and is a very common problem as we get older. That’s an acquired ptosis and is probably the most common type of ptosis there is. However, this lady is very young for that type of situation. It is very important to establish whether or not this is congenital ptosis or if there is any other neurological reason for the ptosis. Once those things are ruled out, especially the systemic issues, then she can consider surgical options.

Typically, Dr. Prasad performs ptosis surgery under local anesthesia with LITE™ sedation which is a deceptively complex procedure. It is done in a very small space in the eyelid area where a very sensitive muscle has to be manipulated so that the eyelid height, shape and contour are symmetric with the other eye. There are situations when someone has one drooping eyelid, he physically lifts that eyelid during an examination and the other eyelid droops. That is one of the manifestations of Hering’s Law which has to do with the way the brain feeds the eyelids so that when you correct one, the other one will droop. He checks and decides whether or not it’s significant enough to do both eyes. He also does a proper evaluation of eye function in terms of how she blinks and how high her eye rolls to protect the eye when she is blinking. These are part of a standard ophthalmological examination.

During surgery, Dr. Prasad often let the patient sit up several times to evaluate what the eyelid level is relative to the effects of gravity. He lets the patient open and close their eyes during surgery. They never feel any pain and they are comfortable. This helps him predict the appearance of the eyes after the surgery is completed. Once surgery is completed, he basically does the same thing he does with other cosmetic eyelid procedures: cold compresses on the eyes, observe, and a week later he take stitches out.

Dr. Prasad suggests that she have an evaluation first by an ophthalmologist, possibly a neurologist to eliminate the other systemic causes of ptosis. Once that’s eliminated, then it’s time to then identify a doctor she feels comfortable with most likely an oculofacial/ oculoplastic surgeon who does a lot of ptosis surgery. Hopefully, this surgeon has a cosmetic sense that resonates with her. Ptosis surgery can really be very fulfilling and can restore the patient’s confidence about the asymmetry of their eyes.

For more information about ptosis correction surgery, please visit our website:

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

How to Stop Further Hair Loss and Get Better Hair Density than a Hair Transplant
How to Stop Further Hair Loss and Get Better Hair Density than a Hair Transplant

A 19-year-old gentleman is losing hair in his crown. He wants to know the best procedure that would increase his hair density.

Hair restoration specialist Dr. Amiya Prasad explains male pattern hair loss is a genetic trait. In his practice, he would first ask about the family history and establish if a patient really has male pattern hair loss. Next, he assesses the scalp through a microscope to look at the level of hair thinning.

Hair loss is established by a general rule of thumb called the Rule of Decades: in late teens to their 20s, 20% of men have hair loss; in the 40s and 50s, there are about 40% or 50% of men having hair loss. Clearly, more than 80% of this gentleman’s contemporaries have lots of hair. With hair transplantation, there is a limited volume of hair that can be moved to help fill an area that doesn’t have enough hair. Now that area that where hair is borrowed from is called the donor area that only has a limited amount of hair. With the continuing rate of progression of hair loss, transplants are not able to restore all the hair that he will continue to lose.

In Dr. Prasad’s practice, he has developed a non-surgical treatment called Hair Regeneration. He uses a material called extracellular matrix which is derived from pig bladder and was originally used for wound healing. He has figured out a system of formulation, technique and a method of delivery to restore hair growth process and thicken hairs. He has over 5 years of data to prove its consistency. In fact, he has hundreds of patients who come from all over the world who have responded remarkably well Hair Regeneration. The earlier someone has Hair Regeneration, the better their results are because hair loss is a progressive event, with some people losing hair faster while others are slower.

Hair Regeneration has been a remarkable change in the way Dr. Prasad approaches hair loss. He has literally stopped doing transplants as a first line of treatment and instead chooses to do Hair Regeneration. In terms of the overall results, he gets significantly better results with the injection and he is able to save thinning hairs compared to doing the transplant. As long as there is existing hair, he is able to get more volume.

In addition, Dr. Prasad would also discuss medical options such as oral finasteride, a drug that inhibits an enzyme called 5-alpha reductase that is responsible for the conversion of testosterone to dihydrotestosterone (DHT). Dihydrotestosterone is the active chemical in the body which goes to the sensitive hairs and causes thinning. If DHT is decreased, hair loss progression is slowed down. The only problem is that many people are concerned about the long-term sexual side effects of finasteride, so a lot of patients are looking for an alternative.

Dr. Prasad would strongly advise not doing a transplant. Patients would find themselves very frustrated with the results, the length of time for the results and the rate of their hair loss progression. Most ethical hair transplant surgeons would share Dr. Prasad’s opinion in that respect.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regeneration-acell-extracellularmatrix-prp-by-dr-amiya-prasad/

Eye Bags Removal Treatment, and What Causes Having Two Kinds of Eye Bags
Eye Bags Removal Treatment, and What Causes Having Two Kinds of Eye Bags

For more information on transconjunctival blepharoplasty, go to:

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

A woman has two layers of eye bags and wants to know how to treat each type.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, deals with this situation every day. He first explains to his patients the cause of the bags. In this woman’s situation, one of her bags is from the eyelid margin or the eyelashes to an area before the second bags begin. That space that became puffy is actually a muscle called the orbicularis oculi. This muscle is activated when someone smiles and has the tendency to bulge when it contracts. Dr. Prasad doesn’t really recommend doing anything for it because it’s a muscle needed to support the lower eyelid. He periodically does a trial of a neurotoxin like Botox® which is non-surgical to see if it contracts less. However, he can’t relax it too much otherwise the patient is at risk for the lower lids sagging.

The puffiness under that area despite the use of creams is due to lower eyelid fat prolapse. From this woman’s photos, it is clear that there is a bulge of fat that has moved forward. The procedure for that is lower eyelid blepharoplasty. If there was a non-surgical option then blepharoplasty would not be one of the top 5 most popular cosmetic surgical procedures. In addition, a lot of devices are marketed to try to non-surgically treat this area and people try to camouflage this with all kinds of injectables. Unfortunately, at a certain point, none of those things can really make a difference because the anatomy is very straight forward - it’s fat that’s pushed forward. MRI studies have actually shown this to be fat that has increased in volume. It generally runs in families, and Dr. Prasad has had the privilege of operating in 3 generations of the same family.

Dr. Prasad’s recommendation would be to do a transconjunctival blepharoplasty. He would address the fat pockets from the inside of the eyelid to avoid any external scar. At the same time, he reduces the puffiness and creates a contour either through the removal, sculpting and repositioning of fat so that it looks like patients never had the bags to begin with. The fat pockets don’t come back. He performs this surgery under local anesthesia with LITE™ IV sedation in his Joint Commission-certified facilities.

For over 20 years, Dr. Prasad has worked on developing systems and processes so that people would not have an aversion to surgery. He does everything to make people comfortable. Lower eyelid surgery can be complex. Unfortunately, many people do have some complications. As a specialist, he gets to fix those complications. He sees patients from around the world to have these procedures revised whether it’s residual fat or fat transfer that have to be removed. Patients also have lower lid retraction where the eyelid was pulled down, and ectropion where the eyelid everted out. In spite of all those potential complications, it can be a remarkably satisfactory surgery when performed well and in good hands. Every surgeon has to deal with these issues no matter how good they are and how much experience they have.

Dr. Prasad recommends that she meet with qualified, experienced cosmetic surgeons and have a physical exam. She must determine the kind of doctor she feels has the level of expertise, knowledge and experience that she trusts to have her eyelid surgery performed. Otherwise, she will be spending a lot of time and money on things that are not likely to work.

Why Puffy Eye Bags Can also Cause Hollow Eyes, and Treatment for Both Problems
Why Puffy Eye Bags Can also Cause Hollow Eyes, and Treatment for Both Problems

For more information on transconjunctival blepharoplasty, go to:

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

For more information on platelet-rich plasma (PRP), go to:

http://prasadcosmeticsurgery.com/injectables/platelet-rich-plasma/

For more information on fractional CO2 laser, go to:

http://prasadcosmeticsurgery.com/prasad-medi-spa/laser-light-treatments/microfractional-co2/

A woman has volume loss under her eyes and dark pigmentation causing them to appear sunken. She wants to know recommendations for her under eye area.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years, can tell by looking at this woman’s lower eyelids are sunken. This area is also known as the tear trough where people are most concerned about hollowing. Above this area is the orbital space where patients may experience lower eyelid fat prolapse. It appears that she has a bulge of fat that is making the adjacent area look hollow. Dr. Prasad assesses this by doing a physical examination where he asks the patient to look up to see if there’s any fat pushing forward.

Beside the tear trough area is where the bone and the cheek meet called the eyelid-cheek junction. This is where it’s very common to lose volume caused by being athletic, genetics and losing volume as you get older. Sometimes, we refer to that as the V deformity or the loss of volume at the eyelid-cheek junction.

Dr. Prasad does a systematic approach when treating patients. If they have lower eyelid fat prolapse, depending on the degree of fat prolapse, he can either choose to do something conservative such as a hyaluronic acid filler like Restylane, Juvederm or something in that family. These fillers are placed in the tear trough to reduce the obvious transition between the puffy under eye bags and the relative hollow underneath. If the fat pockets are more prominent, then he would usually recommend lower eyelid blepharoplasty. In a younger person who doesn’t have extra skin or there’s no other indication to go from the outside, he would typically perform a transconjunctival blepharoplasty.

Dr. Prasad always educates his patients that the eyelid skin is the thinnest skin of the body. Factors such as stress, environmental exposure like sun and smoking can cause this area to thin, look very ashen, irregular and very crêpey. To help skin quality, he uses a material that’s derived from the patient’s own blood called platelet-rich plasma. Platelet-rich plasma refers to the cells called platelets and the plasma that goes with it in the absence of red blood cells and they are responsible for wound healing. From the technology already established in orthopedic and oral surgery, it was discovered that placing the patient’s own growth factors under the skin results in stimulating new collagen and improving quality of skin with more blood supply. In fact, he developed a method of hair loss treatment combining platelet-rich plasma with a material called acellular matrix or extracellular matrix. In select people, he would also consider a laser such as a fractional CO2 laser.

These options would help patients understand their situation more. Dr. Prasad suggests that this woman meet with qualified and experienced surgeons who can help guide her. Not all doctors have the same level of expertise in a given area so she has to identify in her level of comfort a doctor who has the level of expertise that she can trust.

How Sagging Jowls are Treated with Face Lifting Procedures and Facial Fillers
How Sagging Jowls are Treated with Face Lifting Procedures and Facial Fillers

A 40-year-old woman has jowls that bother her a lot. She wants to know if she needs a facelift.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, says that this is a very common issue particularly for a lot of women in their 40s. He explains that there are two aspects of facial aging: one is descent or sagging, the other is volume loss. Facial descent means that the skin and soft tissues are sagging or drooping, which ispartially responsible for the jowls and the little band of skin below the chin which has resulted in a loss of angularity. The other part is volume loss which is gradual diminishment of bone, muscle, fat, skin and soft tissue.

For years, there have been debates between non-surgeons and surgeons about the better procedure for facial aging. Before deciding a procedure, Dr. Prasad often asks patients to do a simple test by lifting the skin upward and seeing what happens to their jawline and neck, often referred to as a "mirror lift". This moves tissue upward to see if it improves the jawline and neck. If it does, a significant element of their concern, specifically the jowls, is related to some descent.

Usually, when someone has this type of situation and they are relatively young, a limited incision face lifting procedure can be considered. In Dr. Prasad’s practice, he does these procedures under local anesthesia with LITE™ IV sedation. It’s still not a shortcut procedure because deeper tissues specifically the layer called the SMAS or superficial musculoaponeurotic system, needs to be addressed in order to maintain the position of the skin. Unfortunately, a lot of doctors advocate deep plane and other lifting procedures. However, an experienced cosmetic surgeon who does a lot of facelifts will customize these procedures based not only on the external physical exam but also what they see when doing surgery. A lot of decisions have to be made in real-time during surgery depending on the quality of the tissue and the effectiveness of the movement. Dr. Prasad thinks that repositioning sagging tissue is probably the most optimal way to restore a youthful appearance when there is descent.

In Dr. Prasad’s practice, he also uses fillers to restore volume. Sometimes he does this when patients don’t have the time yet to do a facelift. In the meantime, he does things to soften the appearance of the jowl using fillers like Radiesse. He routinely places it in an area that is right in front of the jowl called the mandibular notch. Adjacent to that is the area called the mesolabial fold which is often referred to as the marionette line. These areas benefit from augmentation or replacement of some of that loss of volume. Ideally, the sequence would be to lift and then add volume. When the face is thin, there are opportunities in different areas to restore volume. Dr. Prasad’s approach is to always be conservative. He wants to restore just enough so that artistically, the balance of the face is maintained.

Dr. Prasad thinks that she would benefit from meeting with experienced cosmetic surgeons. In his practice, he offers everything from advanced surgery to skin care products and everything in between. He is able to customize a plan for each patient. With 20 years of practice, he always tries to figure out ways to create the right solution for the right time to match the person’s desires and budget.

For more information about face lifting surgery, please visit our website:
http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

To learn more about injectables, please visit:
http://prasadcosmeticsurgery.com/injectables/

Radiesse:
http://prasadcosmeticsurgery.com/injectables/radiesse/

Why the Fat that Causes Eye Bags Won't Go Away with Weight Loss
Why the Fat that Causes Eye Bags Won't Go Away with Weight Loss

A woman lost weight and says she has awful eye bags and lost the youthful volume in her cheeks. She wants to know the best and most affordable method in solving her issues.

Dr. Amiya Prasad, a specialist in facial aging and cosmetic oculofacial plastic surgery practicing in Manhattan and Long Island for over 20 years, deals with this type of problem every day in his practice. He approaches this situation by first defining the problem and discussing the different options based on the level of long-term benefits as well as affordability.

Bags under the eyes are the result of lower eyelid fat prolapse. Lower eyelid prolapse means that the fat that is normally around the eyes has pushed forward and results in puffiness under the eyes. Under eye bags or the fat around the eyes is the last fat in the body to go away when someone loses weight. This is common in people in malnourished situations where much of their body’s natural tissues in addition to muscle are broken down, so Dr. Prasad warns against trying to lose more weight to get rid of the fat that causes eye bags.

The approach to the lower eyelid fat prolapse is to perform lower eyelid blepharoplasty. This can be done in two different approaches: one is from the outside called a transcutaneous approach and another is from the inside called the transconjunctival approach. For most of Dr. Prasad’s patients, he performs from the inside of the eyelid called transconjunctival blepharoplasty to avoid an external incision. The decision on approach is based on physical examinations. The lower eyelids are deceptively complex and many plastic surgeons end up having the lower eyelid pulled down or retracted and sometimes even everted. The lower eyelid has a lot of critical anatomic structures that need to be in balance in order to get good results.

When Dr. Prasad evaluates the lower eyelids, he also looks at skin quality and texture. He would consider procedures such as fractional CO2 laser as well as the use of platelet-rich plasma (PRP)derived from the patient’s own blood in order to stimulate new collagen and to improve the skin quality.

The apples of the cheeks are an area which is referred to as the malar fat pads or the submalar space. When someone has lost volume in this area, Dr. Prasad performs different facial rejuvenation surgeries such as face lifting, cheek implants, etc. He tries to decide how much volume was lost from weight loss and from sagging or descent. When the face descends when one gets older, plumping it out might not look so good because the skin doesn’t have the tone or the resilience to hold that volume. In the mid facial area, augmentation can be performed with a facial implant such as a submalar implant, or a filler such as Radiesse or Restylane. Dr. Prasad also tends to use platelet-rich plasma to further enhance the volume in this area. He would also do fat grafting which is taking fat from one area of the body and place it into this area to augment it further.

In terms of affordability, Dr. Prasad comes up with different scenarios for his patients. As long as the patient understands what those scenarios and the costs are, he tries to come up with a structure that is affordable but is also satisfactory. A lot of people buy lower price options and they end up wasting a lot of money. High quality and cost do often go hand-in-hand. This is an investment where patients will reap the benefits after a long time. As long as the patient communicates with their doctor, they should be satisfied.

For more information on transconjunctival blepharoplasty, go to:

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

For more information on platelet-rich plasma (PRP), go to:

http://prasadcosmeticsurgery.com/injectables/platelet-rich-plasma/

For information on facial implants, go to:

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

The Limits of Fillers for Swollen Under Eyes and Why Lower Eyelid Surgery is a Better Option
The Limits of Fillers for Swollen Under Eyes and Why Lower Eyelid Surgery is a Better Option

A woman thinks she has swelling under her right eye only. Doctors gave her different opinions on treatment, with one saying fillers and the other saying eyelid surgery. She wants to know the best under eye treatment.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, says that the swelling below this woman’s eyelids is called lower eyelid fat prolapse. Fillers are also useful for someone who has a small amount of fat prolapse. Dr. Prasad uses fillers to camouflage that little fat prolapse before they are ready for a blepharoplasty. He continuously sees patients who have had fillers to correct their significant fat pockets under their eyes. Their fillers have caused their puffy bags to become more pronounced. Most of these people who come for revision or some kind of correction ultimately require an injection of a material called hyaluronidase to dissolve their filler.

Dr. Prasad recommends blepharoplasty because fillers are not going to be beneficial to someone like this woman. That doesn’t mean that fillers aren’t helpful in other areas. When someone has volume loss in the cheek area, Dr. Prasad may add volume in the cheek area to correct the imbalance between the lower eyelid fat prolapse and the hollowing of the cheek. However, for herniated fat, lower eyelid blepharoplasty is the best solution.

If patients are afraid of surgery, they may be better off doing nothing than getting an injectable. However, in this woman’s situation, surgery would be beneficial. In Dr. Prasad’s practice, he alleviates the fear of surgery in his patients. His Joint Commission approved facilities are within his office and he tries to make the surgery less scary by having a more family type of environment where they know everybody and they’re comfortable, as opposed to going to a hospital or surgery center where there’s de-personalization. The procedures he does for lower eyelid blepharoplasty are done under local anesthesia with LITE™ IV sedation which means that there’s often very quick recovery. In fact, the amount of swelling and bruising is often less than people having injectable fillers. With surgery, he has a lot of control so his patients don’t look very swollen or bruised after a week.

With that said, Dr. Prasad thinks that she needs to first evaluate who the doctors she saw were and she must understand her options. It’s all about selection and making intelligent decision.

For more information on transconjunctival blepharoplasty, go to:

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

Facial Aging Treatments in Early 40s Depends on Individual Cases Rather Than Definite Age
Facial Aging Treatments in Early 40s Depends on Individual Cases Rather Than Definite Age

A 41-year-old woman has sagging skin. She wants to know if the best facial aging treatment options for her at a relatively young age includes a facelift, or non-surgical fillers.

Dr. Amiya Prasad, a board certified cosmetic oculofacial plastic surgeon practicing for over 20 years, says most of his patients for face lifting surgery are women over 45-years-old. The youngest patient he has done facelift for was 37-years-old and close to that was a woman who was 42. From his experience, he concludes that it really depends on what the situation is more than a definite age.

One of the goals of face lifting surgery is to restore the definition of the jawline and to lift sagging tissue from the cheek to the jawline or to the neck. When Dr. Prasad determines if a patient is a candidate for face lifting surgery, he looks at how much they can slide up the skin. A lot of women will do a mirror lift at home by pulling the skin up. If there’s a lot of slide and their jawline improves, then they may be a candidate. This lady may not need an extensive full face and neck lift, but she may be a candidate for one of the smaller scar limited incision types of facelifts. However, the one thing Dr. Prasad cannot do with photos is a physical examination.

People with similar cases to this woman may be able to explore some other options. Some patients in Dr. Prasad’s practice will do something like a limited liposculpturing and reduce fat in the jawline so that the jawline is seen more clearly. He also may address the indentation at the jawline called the mandibular notch. This is the area where there may be accentuation of the jowl. He can fill that area with Radiesse® or another filler.

This woman may be a candidate for a facelift but she really should meet with cosmetic surgeons and learn about other options. She may be able to buy some time with just fillers by filling in some relative hollows to create a smoother jawline. Many of Dr. Prasad’s patients who know they will be having a facelift in the future are often time limited or have already used vacation time. In the meantime, they can do a few things to strategically improve the appearance of their jawline. Sometimes, it involves putting fillers in the nasolabial folds or the cheeks so that they look more youthful. Facial aging, particularly in women, is very much accentuated in the lower facial area or the lower third of the face.

Dr. Prasad recommends she meet with qualified experienced surgeons who specialize in facial aging. She should learn more about her options and together with her doctor develop a game plan that works for her.

For more information about Face lifting surgery, please visit our website:

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

To learn more about Radiesse, please visit:

http://prasadcosmeticsurgery.com/injectables/radiesse/

Why Choosing a Cosmetic Surgeon for Facelift Surgery Based on Price Leads to Compromised Results
Why Choosing a Cosmetic Surgeon for Facelift Surgery Based on Price Leads to Compromised Results

A woman has just finished a very stressful period in her life and is considering a facelift. She wants to know the least expensive approach but also the most effective for her.

Dr. Amiya Prasad, a specialist in facial aging and as a cosmetic oculofacial plastic surgeon for over 20 years, says that he has seen many patients who made bad decisions because they based their doctor of choice on their budget. There are lots of costs to delivering quality care which includes the surgeon’s fee, anesthesia and facility costs. Patients have to be cautious whenever someone offers them a lower price solution for something that another doctor is offering at a higher price. Cosmetic surgeons will often charge a higher price when doing a high level of quality work than doing volume procedures. From his experience, any doctor or surgeon who does volume work rarely does high quality work. The artistry of cosmetic surgery requires focus and time. If he had to do upper and lower eyelids, face and necklift and cheek and chin implants, it’s going to be a different experience for the fourth patient compared to the first. It’s very difficult to do high quality work consistently. In his practice, he is more about the quality and the boutique style in trying to perform exceptional procedures for each patient.

In this woman’s case, if she likes a doctor and she feels comfortable, then this doctor may be able to counsel her as long as she is willing to do something that may be less expensive that are satisfying the major concerns that she has. Dr. Prasad would caution her not go with price. There are many companies that have been proliferating by trying to do high volume and have very convincing marketing messages, but the quality is just not there. Patients have to figure out a way to invest the right money with the doctor they trust. He has seen patients who come from all over the world that had shortcut procedures and didn’t have a beautiful, crisp jawline and a nice, smooth neck.

Dr. Prasad suggests that she doesn’t do anything in haste and think of what her priorities are. She must look at her budget and defer the procedure until she can afford it so that she can get it done the right way. Unfortunately, when people have cheap cosmetic surgery and they get bad results, they end up having multiple times the cost to correct the procedures. The reality of life is that a person can never get something cheap that’s equal in value to something that's expensive. She must go back to the plastic surgeon or cosmetic surgeon who she likes and discuss her issues and concerns. She must develop that relationship so that she can start in her healing process after her long, stressful period.

For more information about face lifting surgery, please visit our website:

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

How to Achieve Symmetry in Eyelid Ptosis Surgery
How to Achieve Symmetry in Eyelid Ptosis Surgery

A woman has unilateral ptosis. She wants to know the procedures that would achieve symmetry in both eyes.

This is a situation that is very well known to oculplastic or oculofacial plastic surgeons. These are surgeons who are trained first in eye surgery though ophthalmology and then specialized in surgery of the eyes. Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing in New York for over 20 years, explains about his process and how he makes decisions about whether or not to operate on one eye or to operate on both eyes.

In terms of making the decision in operating in one eye or two eyes, Dr. Prasad measures the upper eyelid height, called the margin reflex distance, which is the distance from the eyelid margin to the light reflex of the pupil. He also tests the muscle function which is the amount of movement that the eyelid makes when looking down and up. Then he does a test for Hering’s Law, a physiologic manifestation of how the brain sends a signal to the upper eyelids to open. He lifts the eyelid that’s more droopy and looks to see what happens to the other eyelid. Very often, when the droopy eyelid is lifted, the other eyelid will actually droop.

For people who have congenital ptosis, it is not unusual for the ptosis to be manifested in both eyes, but it can be more significant in one eye. In such cases, Dr. Prasad makes the decision with the patient to operate in both eyes because it is not advisable to lift one eye and then the other eye drops. During surgery, Dr. Prasad lifts the eye less in order to try to get the symmetry. In addition, he lets the patient sit up to make sure that the height, contour, shape and maximized symmetry are achieved.

As for the eyelid crease if there’s more soft tissue and fat on one side versus the other, then Dr. Prasad will do a blepharoplasty or remove some extra skin and fat to try to maximize the symmetry. If she wants fullness in the contra lateral eye that has less volume, then procedures such as fat transfer or even hyaluronic acid filler can be entertained. However, Dr. Prasad tends to discourage that because getting the eyelid height, contour, shape, balance and symmetry is already a significant challenge. A small percentage of patients may have the eye too open or over corrected, or even too low or under corrected - it’s always about customizing to the individual situation.

Dr. Prasad recommends that she meet with experienced oculofacial plastic surgeons. He doesn’t think that general plastic surgeons who are boarded by the American board of plastic surgeons are interested in doing this. He thinks she’ll find oculoplastic surgeons who are comfortable and more than qualified to do this surgery.

For more information on ptosis correction surgery, go to:

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

Causes of Swelling after Asian Eyelid Surgery & How an Eyelid Specialist Reduces Recovery Time
Causes of Swelling after Asian Eyelid Surgery & How an Eyelid Specialist Reduces Recovery Time

A female is 3 months post-op and her eyes are still swollen. She wants to know if this is normal.

Oculofacial plastic surgeon Dr. Amiya Prasad explains that surgical healing involves the areas where the surgeon has done surgery whether it’s a simple laceration closure or a more complex surgery. This recovery timeframe which can take up to a year. Incision healing and swelling are not correlated. Swelling is caused by a variety of reasons, one being reactive swelling or swelling that occurs after surgery. Another cause is fluid stasis where there’s fluid just sticking around in the circulation or in the lymphatic system.

Wound remodeling is a dynamic process that takes place on a cellular level. The results of any surgery can take as long as a year for any patient to fully appreciate. Fortunately, this doesn’t mean that patients can’t look good after surgery. In Dr. Prasad’s practice, when he does Asian eyelid surgery, most of his patients get back to work in a week and most of them can look pretty good within a month. There’s a mild degree of swelling which he checks at 3 months, and again if the swelling persists, but in his practice swelling rarely lasts that long. He has developed a process to minimize the active swelling in procedures such as Asian eyelid surgery using the non-incisional method or the excisional method. He also does more complex procedures such as ptosis surgery where he works on the levator muscle and advances it and it is a longer procedure. In these procedures, he still gets his patients to look pretty good faster, but swelling and other factors can take a little time.

Dr. Prasad thinks that she must communicate with her surgeon who she must have chosen based on her research on the level of his experience, and he will be able to guide her on what to expect. 3 months is still a little premature to anticipate or to project that this is the appearance she’ll have beyond a year. It’s important that she make observations. At the same time, she must keep an open line of communication with her surgeon so that she can be evaluated, examined and understand where she’s heading.

For more information about Asian eyelid surgery, please visit our website:

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

Why Sudden Puffy Eye Bags with Existing Medical Conditions are Best Treated Non-Surgically First
Why Sudden Puffy Eye Bags with Existing Medical Conditions are Best Treated Non-Surgically First

A relatively healthy 33-year-old healthy with anemia, colitis, and petrositis has sudden under eye bags. She wants to know the appropriate measures for her minor eye bags.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon specializing in this area for almost over 20 years, says that many people come to him with different variations of a story like this woman. Bags under the eyes represent lower eyelid fat prolapse which means that the fat that is normally around the eyes pushes forward. Most of the time, even with a clinical history of sinus issues, allergies, sinus surgery or other factors that can cause facial swelling, there is still often a hereditary factor. When people first notice under eye bags in the absence of a history like this woman’s, they always mention that they have some good days and some not good days. As time goes on, they tend to have puffiness that is always present.

Given her current medical situation that’s still evolving especially with anemia being a factor, Dr. Prasad thinks that it is reasonable for her to consider a non-surgical option such as the use of a filler like a hyaluronic acid. In his practice, for under eye pockets that are very early and minimal, he does perform the application of hyaluronic acid such as Restylane and places it into the tear trough area. This is to soften the transition between the puffy bags and the valley underneath the eyes which make the puffy bags look puffy. Sometimes, some doctors will be a little overzealous and try to fill in the area and then the results look terrible. She should also be mindful that hyaluronic acid fillers can also cause swelling so the approach should be relatively conservative if she is going to try that first.

In Dr. Prasad’s practice, he commonly combines hyaluronic acid fillers with platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood and it is the concentration of the healing and growth factors necessary for wound healing. It helps improve the skin quality and acts very well in synergy with hyaluronic acid.

With the issue of this woman’s medical history still influx, Dr. Prasad thinks conservative measure are probably best explored rather than moving forward directly with surgery. At the same time, it is probably her benefit to not do any kind of intervention and observe whether or not the fat pockets are consistently there for weeks at a time. This will give her a sense of the constant nature of the fat pockets being present.

For more information on lower eyelid surgery, go to:

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

For more information on transconjunctival blepharoplasty, go to:

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

For more information on platelet-rich plasma (PRP), go to:

http://prasadcosmeticsurgery.com/injectables/platelet-rich-plasma/

How Upper Eyelid Blepharoplasty Can Reveal or Cause Eyelid Ptosis
How Upper Eyelid Blepharoplasty Can Reveal or Cause Eyelid Ptosis

A woman had upper blepharoplasty 2 weeks ago and one eye looks smaller than before the surgery. She wants to know what kind of revision surgery can be done to get the results she was hoping for.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, says that based on this woman’s photos, she has ptosis. Ptosis means that the upper eyelid is lower and closer to the pupil. In an evaluation, surgeons have to determine if the patient’s ptosis is pre-existing meaning that prior to surgery, the eyelid was low and there was asymmetry between the two eyes. If the eyes were equal and the upper eyelids were symmetric, then the surgeon has to determine if it was due to injury during the surgery or due to a sequence of swelling and trauma. If that is the case, then the ptosis can resolve on its own. If there’s a lot of swelling, it is called traumatic ptosis.

Ptosis is one of the most common procedures Dr. Prasad does. He usually allows a little amount of time after the initial surgery to determine if the eyelid height is stable. This timeframe is based on observation during several week gaps between visits to determine if the ptosis is improving during that timeframe. If it is not improving during the first to 2 months, then he can move forward with doing some type of revision surgery. He tries to avoid operating on tissue that is swelling. Unfortunately, having the asymmetry can be very distressing and so he customizes his approach for each individual patient. He often sees patients come in for revision surgery from other doctors with their pre-operative photos and he can actually make a comparison to determine what the situation is.

Dr. Prasad thinks it is important that this woman still communicate with her primary surgeon who did her original surgery original. She must review her photos and discuss with her doctor what to anticipate and expect. No one knows her anatomy better than the original operating surgeon. If she feels that her doctor is comfortable and confident about the ptosis, she can wait it out. If it is beyond a certain point, she can probably conclude that the ptosis is not going to get better and a ptosis repair might be necessary.

Ptosis repair in Dr. Prasad’s practice is performed under local anesthesia with LITE™ sedation. He actually moves the muscle that lifts the eyelid called levator muscle and adjusts it. He lets the patient sit up during surgery to maximize the symmetry and to make sure that the eyes look balanced with the gravitational aspect being in place. It’s a more complex surgery than most general plastic surgeons are familiar with. It’s very unique to oculofacial plastic surgery so patients don’t want to rush a procedure like this. Every ptosis surgery has a risk of needing more surgery as the eyelid can be too high or can be too low afterwards. If this woman’s situation is a manifestation of swelling at the cellular level or at the level of the tissue behind the eyelid, then it can potentially get better on its own. Dr. Prasad thinks that within the first 2 months, there is no harm in waiting. She can even wait much longer than that like 6 months or longer and have the ptosis surgery performed. Seeing how much this woman is very concerned, most likely, expediency maybe the best solution for her.

For more information about eyelid surgery, please visit our website:

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

For more information about ptosis correction surgery, please go to:

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

Facial Aging - Why Facelifts Do No Not Replace Volume Enhancement
Facial Aging - Why Facelifts Do No Not Replace Volume Enhancement

A 57-year-old woman received Botox® and Juvederm a few months ago, but wants to know about procedures that are more permanent.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, board certified in facial cosmetic surgery, body, and breast surgery, deals with everything from head to toe. Facial aging is one of the popular areas he focuses on. He explains that facial aging is composed of volume loss which means loss of bone, muscle, fat and soft tissue. There is a role for volume replacement using fillers, fat transfer or surgical implants such as cheek implants or chin implants. The other facial aging issue is descent or loosening of the tissue, including: the skin, and the soft tissue framework under the skin called the SMAS or superficial musculoaponeurotic system. When tissue descends there’s a role for some type of lifting procedure. The goal of any lifting procedure is to restore the natural anatomic relationships.

When a patient comes to Dr. Prasad’s office with multiple problems, he first asks them the things that bother them most. Prioritizing problems helps him strategize a treatment plan. A procedure with a more permanent result would be a surgical procedure. A surgical procedure does not mean a patient never has to consider doing fillers, injectables or treatments such as Botox® or Dysport because a facelift may restore anatomic relationships, but it doesn’t restore volume loss. This woman has an opportunity to have some restoration of her jawline and the soft tissue that is descending. There’s also some loose skin under the neck and some banding which is called platysmal bands.

In Dr. Prasad’s practice, patients will have opportunities to consider procedures such as a limited facelift and a more extensive facelift. It is not more likely that this lady will need a more extensive face and neck lift. Since her facial structure is relatively thin, a conservative procedure is probably best for her. Dr. Prasad would try to restore a crisp jawline and define the neck. He doesn’t think that cheek lifting is the best method for her. Cheek lifting usually means some type of temporal incision using an endoscope to lift the cheeks upward or some type of procedure from the eyelid approach called a soof lift. From his experience, those procedures look very unnatural and they don’t address the underlying issue of the partial descent of the cheek when there’s also a lot of volume loss. In Dr. Prasad’s opinion, he would do a combination of a submalar implant which is a permanent implant and place that on the cheek bone to give volume rather than trying to lift it. Volume loss can be also corrected with fillers such as Radiesse, Juvederm, Restylane and Voluma.

Restoration of volume is something that is going to be a benefit for this woman. In addition, a surgical solution which is to pull all the sagging tissue back to improve jawline and definition of the neck and some of the sagging cheek will also benefit her. Dr. Prasad suggests that she find the right doctor. The ideal relationship is when a surgeon provides comprehensive solutions and providing the surgical care patients need to reach a specific objective.

For more information about Face lifting surgery, please visit our website:
http://prasadcosmeticsurgery.com/prasad-face-eyes/facelifts/

To learn more about injectables, please visit:
http://prasadcosmeticsurgery.com/injectables/

Botox:
http://prasadcosmeticsurgery.com/injectables/botox/

Dysport:
http://prasadcosmeticsurgery.com/injectables/dysport/

Juvederm:
http://prasadcosmeticsurgery.com/injectables/juvederm/

Radiesse:
http://prasadcosmeticsurgery.com/injectables/radiesse/

Restylane:
http://prasadcosmeticsurgery.com/injectables/restylane-perlane/

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