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

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

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

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

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

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

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

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

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

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

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

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

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

What is Transconjunctival Blepharoplasty?
What is Transconjunctival Blepharoplasty?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Preparation for eyelid surgery is a straightforward matter.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

For more information, visit our website:

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

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

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

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

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

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

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

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

For more information, visit our website:

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

Brow Lift or Blepharoplasty - Why Upper Eyelid Surgery Results in a More Natural and Defined Look
Brow Lift or Blepharoplasty - Why Upper Eyelid Surgery Results in a More Natural and Defined Look

A woman is in her late 30s and she has pale skin prone to wrinkling. She feels her eyelids are heavily hooded. She wants to know the best procedure for her.

Dr. Amiya Prasad, an oculofacial plastic surgeon, wrote a book called “The Fine Art of Looking Younger” where he explained that accelerated skin aging is due to genetics, environmental factors such as sun exposure, and/or smoking. It has always been his desire to help people understand the process of aging. In the context of an individual’s face, the surgeon doesn’t have to address everything to get a rejuvenated look.

In this woman’s situation, Dr. Prasad suspects that the brow position that she has now is not very different from what it was 10 years ago. In journals in the plastic surgery field, there are examples of people showing before and afters of brow height from browlift. Dr. Prasad respectfully disagrees with the choices of authors made on lifting brows because these patients look way too surprised.

Dr. Prasad thinks that the better approach for this woman is a conservative upper eyelid blepharoplasty. By doing an upper eyelid blepharoplasty, she would be able to achieve a more definition of the upper eyelid. By keeping the brows stable, she is able avoid the surprised look. There are a lot of people walking around whose eyebrows are lifted a little too much and they look perpetually surprised. If the patient wants to get a sense of that, they just have to raise their eyebrows a few millimeters and they’ll see how much of an impact it has on their facial expression.

When a person has upper eyelid hooding, it actually ends up dominating the shape of the eyes. A person may have a beautiful almond shape to their eyes but if there is hooding, it makes the eyes look sad or tired. Dr. Prasad thinks that she would probably benefit from an upper eyelid blepharoplasty but the key is not too overdone. Dr. Prasad has patients who come from all over the world who are unhappy with over aggressive removal of skin and fat around the eyes. The upper eyelids are a great challenge because if so much volume is removed, there is extensive amount of work that needs to be done in order to restore that.

Dr. Prasad always tells his patients to communicate with him. He draws it out so they see what they’re going to do so they have a clear understanding of what’s going to happen and what to anticipate. He also rolls their eyelids in to show them what they can expect. Dr. Prasad thinks being conservative is a good strategy. It’s always possible and necessary to enhance, but he thinks if someone is this young, it’s really important not to be overly aggressive.

Dr. Prasad’s advice would be to do the upper eyelid blepharoplasty, do some research, find qualified experienced artistic cosmetic surgeons and get a sense what the desired look is. Once she’s comfortable with that, she should move forward with the procedure. In his practice, he does everything under local anesthesia with sedation so the recovery is a lot faster. In the modern world, people need to get back to their normal lives as quickly as possible.

For more information, visit our website:

http://prasadcosmeticsurgery.com/from-the-desk-of/is-a-browlift-or-upper-blepharoplasty-procedure-right-for-you/

Why a Hair Transplant Won't Stop Male Pattern Baldness, and a Non-Surgical Hair Loss Treatment
Why a Hair Transplant Won't Stop Male Pattern Baldness, and a Non-Surgical Hair Loss Treatment

A gentleman in his mid-twenties always had high, broad forehead. He wants to know if he is a good candidate for a hair transplant.

Dr. Amiya Prasad, a hair restoration specialist, explains that in hair restoration there is the Rule of Decades: if a person is in their 20s, only 20% of his contemporaries will have hair loss, while 80% will have a lot of hair. It’s natural for someone to be concerned about a receding hairline. Hair loss is related to family history.

In the United States, there are two drugs that are used for male pattern hair loss: finasteride which is a 1 milligram tablet that is taken daily by prescription, and minoxidil which is a topical solution or foam that is applied nightly. Finasteride is used based on the concept and understanding that a substance in the blood called dihydrotestosterone (DHT) can cause hair follicles to thin and to disappear. Finasteride blocks the enzyme 5-alpha reductase which converts testosterone to dihydrotestosterone.

Unfortunately, in Dr. Prasad’s clinical experience, a lot of younger males who have frontal receding hair loss tend to not respond well to finasteride. It may slow hair loss to a small degree but some people who were taking finasteride religiously still lost hair. On the other hand, minoxidil is not likely to make a significant difference either.

In the past several years, Dr. Prasad has been committed in helping his patients with a material derived from pig bladder called extracellular matrix (ECM) made by ACell. Extracellular matrix was discovered serendipitously when it was applied for the wound healing process for a hair transplant. Hair transplantation is the movement of hair follicles from the back of the scalp called permanent zone or the donor area. Hair follicles are taken by a strip method or follicular unit extraction and planted them in areas where there’s lacking hair. When extracellular matrix was used, it actually resulted not only in wound healing in that area, but the thinning hair also became thicker.

In Dr. Prasad’s practice, he has developed a formulation, method and delivery technique that has helped people from all over the world. He combines extracellular matrix with platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood. It is a concentration of their platelets into a serum that has growth factors which help in the wound healing process. Thinning hair becomes thicker, progression of hair loss appears to be stopped, and has helped a lot of his patients particularly younger people in their 20s and 30s. Dr. Prasad used to do a lot of hair transplantations, but now he changed the approach. Presently, he will treat with Hair Regeneration and restore the hair that was thinning. He can’t bring back hair that was gone. But if it’s thinning, he can reverse that thinning and get the hair to be thicker.

When a patient undergoes microscopic examination of the scalp, they’ll find a lot hair that is thinning. Hair doesn’t just fall off, it actually goes into a growth cycle. There’s a normal amount of 50-100 hairs that’s shed per day. When those hairs grow back after the catagen and telogen phases of hair growth which is about 3-5 months, those hairs come back looking thinner. With Dr. Prasad’s treatment, he has observed that the hair that is shed comes back thicker. Over 5 years of data, a handful of patients consider this injection. It seems to be a real tremendous benefit for people, men and women with thinning hair.

Dr. Prasad discourages doing a transplantation because the patient could still lose hair after the procedure. An example is someone who had bad transplants. Their hair was fine with the existing hair with the transplants. But once the hair thinned and disappeared, all that was left was the transplants and that created the pluggy look that everyone recognizes.

Dr. Prasad’s suggestion is to get a proper diagnosis. This may mean visiting a dermatologist, getting some microscopy done in the top of the scalp to learn if they are having significant miniaturization of the hairs and learn about the options. They may want to try taking finasteride first or using minoxidil. They must understand and investigate their options such as medical and Hair Regeneration and pursue whatever they think is right for them after consultation with qualified physicians.

For more information, visit our website:

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

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

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

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

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

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

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

For more information, visit our website:

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

How to Treat Sagging Skin and Wrinkles Around the Mouth with Natural Looking Facial Cosmetic Surgery
How to Treat Sagging Skin and Wrinkles Around the Mouth with Natural Looking Facial Cosmetic Surgery

A woman has sagging skin around the corners of her mouth she thinks make her look old. She wants to know the best procedure for this and the sagging around her chin.

Oculofacial plastic surgeon Dr. Amiya Prasad explains that facial aging is the descent or weakening of the support structure of both the skin and the underlying tissue called the SMAS (superficial musculoaponeurotic system). When people come to his practice with this concern, they do a mirror lift where they physically and vertically lift everything upward. Through this, they are able to see if a facelift is an appropriate procedure for them.

When patients do their research, they will see terms such as facelift, face and neck lift, and neck lift. They’ll also come across proprietary names that have been given to various quick recovery procedures or procedures that claim to be remarkable discoveries that are done by a particular company. It can certainly be confusing. A lot of times people are afraid of having a procedure like a facelift or face and neck lift because they’ve seen pictures in magazines, read horror stories on the web or they know someone who had a procedure and that person went through a very rocky healing process.

In Dr. Prasad’s 20 years of practicing cosmetic surgery, specializing in facial aging effects on the eyes and face, he has seen a lot of fads come and go. Definitively, he says that the best thing is to choose the surgery that gives the patient the best result that will be long-term and is done properly. There was a point in time where people were very excited about short scar limited incision facelifts and unfortunately for people who have more volume shifting in their face, they can get an improvement but they don’t necessarily get everything that they want. A consultation is very important and the patient should make sure that you have a very good communication with the surgeon they choose.

In Dr. Prasad’s practice, he developed over 20 years a quick recovery concept without doing shortcut procedures. He decided to do procedures that were typically done under general anesthesia, but performs them under local anesthesia with minimal sedation. By developing this technique, he was able to get the full benefit of a more proper procedure and still reduce the risks and prolonged recovery related general anesthesia.

When Dr. Prasad first moved to the Upper East Side in New York City, he was very shocked to see how many people looked very pulled and over tightened. Overtime, he learned that the desired look is based on the aesthetic style of both the patient and the surgeon. He wrote a book a few years ago called “The Fine Art of Looking Younger” where he explained that there are different surgeons with different styles. His particular style is more of a natural look, other people are more of an exaggerated look and it is a matter of person’s individual taste and comfort level. He always feel that every patient’s face has a unique character. It is his role as their surgeon to maintain that character and to restore the key elements of their appearance that make them look more youthful, such as elevating the cheek, improving the jawline, and improving the neck.

At this point, Dr. Prasad thinks it’s best for this woman to start meeting with surgeons and learn about each individual surgeon’s particular style of how they do their procedure. He can’t stress enough the importance of communication. When meeting with doctors, make sure that they are given the appropriate amount of time so they feel comfortable and understand what they are committing to.

For more information, visit our website:

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

How to Reduce Eye Bags Through Lower Eyelid Blepharoplasty and Treat Hyperpigmentation Under Eyes
How to Reduce Eye Bags Through Lower Eyelid Blepharoplasty and Treat Hyperpigmentation Under Eyes

A 29-year-old woman has had bags for as long as she can remember. She also has hyperpigmentation which she feels make it look worse. She wants to know the best way to improve the look of her under eyes, and has avoided fillers because she read they can make it worse.

For years, non-surgeons tried to help patients with under eye bags by filling in hollows using hyaluronic acid fillers such as restylane and Juvederm to try to camouflage the appearance of the bags. In Dr. Amiya Prasad’s practice, he does this type of procedure but he says there is a limited volume that can be placed that can be effective. Because this material is so soft, patients actually have the hyaluronic acid removed by an enzyme called Hyaluronidase. This is because fillers don’t work on puffiness that’s beyond a certain level.

Puffiness under the eyes is caused by lower eyelid fat prolapse- the fat normally around the eyes pushes forward and creates a bulge. Puffiness make the eyes look puffy and tired, and is mainly a genetic trait. In fact, Dr. Prasad has operated on several generations in the same family with this type of situation.

In a young person like this woman and if there’s no excess skin, Dr. Prasad will do something called a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a procedure where he approaches the lower eyelid from the inside thereby avoiding an external scar. This way, he is able to reduce, reposition and address the herniated the fat. Through this procedure, he can make the eyes appear like the person has never had bags under their eyes. The hesitancy about doing surgery is because of the type of anesthesia. Fortunately in his practice, he does these procedures under local anesthesia with LITE™ IV sedation. Through this process, it is very easy for younger people to have it done with minimal interruption and disruption in their lives. People have told Dr. Prasad that if they knew it was this easy, they would have had the surgery done sooner.

Pigmentation can be due to genetics just like a regular skin colour, or from environmental factors such as sun exposure or people who work outside or have spent a lot of time with incidental sun exposure. To help people with dark circles or pigmentation, Dr. Prasad does an injection of platelet-rich plasma (PRP). Platelet-rich plasma is from the patient’s own blood. He draws the blood like a regular lab test and then spins it so that he can concentrate the platelets, the serum, the healing and growth factors necessary for wound healing. When this is injected on the skin or under the eyes, there is a significant improvement in skin quality. In some cases, he also does laser to tighten and to resurface the skin. So there are complementary procedures to help maximize the overall appearance of the lower eyelids.

At this point, Dr. Prasad’s recommendation is that she meet with qualified experienced cosmetic surgeons and discuss her options as to how to address this area. He also suggests avoiding general anesthesia for the procedure to minimize risks and speed up healing and recovery.

For more information, visit our website:

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

Why Temporary Swelling after Ptosis Surgery Occurs and Causes Temporarily Heavy Eyelids
Why Temporary Swelling after Ptosis Surgery Occurs and Causes Temporarily Heavy Eyelids

A woman had blepharoplasty and ptosis repair done twice. However, one eye is smaller and the fold feels very heavy. She wants to know if this heaviness can be fixed.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years, says that ptosis is one of those procedures where a surgeon can do a great job and create something that looks fantastic and beautiful. However, it can also result in not just one but more than one revision surgery. It can be understood that the sense of heaviness is often the result of internal or tissue swelling and it can also cause the eyelid to drop a little, particularly if there is enough swelling that causes a physical weight on the eyelid. It is sometimes referred to as mechanical ptosis where it is actually a lesion weighing down on the eyelid. In addition, the healing process of the levator muscle takes a little bit of time so that the eyelid may come up a millimetre or half a millimetre and make it look asymmetrical.

To ensure the likelihood of success, in other words getting the proper: height, contour, shape, and symmetry, Dr. Prasad actually lets the patient sit up during surgery. The patient doesn’t feel any pain because they’re numb but they’re alert enough for him to look at their eyelid and make adjustments while they are sitting up to get as close as possible to the final result. Statistically, about 95%-98% of the time, he is able predict that if it looks good during the procedure,and it will look good after. Of course, over his 20-year career, there are exceptions to that rule.

Dr. Prasad suggests that it is important that she meet with her doctor. Both of them should discuss the feeling of heaviness on the eyelid and let the doctor examine her so that she can get an idea of what to anticipate. Any surgical procedure, regardless of location, can take up to one year for full healing. In Dr. Prasad’s experience, there are even scars and other things that further mature beyond a year. In this area of delicate tissue which is less than a half a millimetre in thickness, one can understand that a little swelling can cause a lot of impact. She should probably allow some time for adjustment. In addition, in ptosis surgery, the levator muscle may not move in the same way as the other eye and it may take some time and adaptation.

Why Hair Transplants Don't Stop Male Pattern Baldness and a Hair Regrowth Treatment that Does
Why Hair Transplants Don't Stop Male Pattern Baldness and a Hair Regrowth Treatment that Does

A 25-year-old male is having continued hair loss despite using minoxidil and Deutomix. He wants to know another alternative from taking these medications.

Dr. Amiya Prasad, a hair restoration specialist, explains that male patter hair loss or male pattern baldness is a genetic trait which runs in families and has variable expressions. It's not a direct dominant or recessive trait and can affect only certain siblings - one can have lots of hair while another can have tremendous hair loss.

In the United States, the drugs that are approved for hair loss are finasteride and minoxidil. Finasteride is a 1 mg tablet that is taken daily and is used to inhibit an enzyme called 5-alpha reductase. 5-alpha reductase converts testosterone to dihydrotestosterone (DHT). Dihydrotestosterone will affect susceptive hair follicles which will then thin and eventually disappear. Minoxidil is a topical that is available over the counter. However, minoxidil does not stop the progression of hair loss. Finasteride can slow down the progression because it's working systemically from the inside in a specific way. Unfortunately, a significant percentage of men do not respond to finasteride. At this time, many men in their 20s and 30s are concerned about reports of long-term sexual side effects, so they refuse to take it altogether.

The traditional alternative is to do a hair transplant. A hair transplant is a surgical relocation of hairs that are resistant to hair loss which are located at the back of the scalp called the donor area. Genetically resistant hair means hair from this area will never fall out - no matter how long one lives, the hair will remain in place. Unfortunately, the donor area is limited and there are just a few hairs that a surgeon can move.

In general, it is more acceptable to have hair loss in men in their 30s, 40s or 50s. In Dr. Prasad's experience in 20 years of practice, men in their 20s expect to have a lot more hair volume. The Rule of Decades, a rule of thumb in hair restoration, states for men in their 20s, 20% will have hair loss while 80% will have a lot of hair. Even with transplant, a person won't get the volume they desire and will only have a limited amount of hair. In addition, nothing is stopping the progression of hair loss, therefore a person will continue to lose hair and eventually, their transplant area or donor area will be tapped out.

In Dr. Prasad's practice, he has had tremendous success with a method of restoring thinning hair called Hair Regeneration. This concept is something that he developed over several years and has been very successful in treating male and female pattern hair loss using a material called extracellular matrix. He developed a process of protocol and a method that combines platelet-rich plasma and extracellular matrix. Platelet-rich plasma is the patient's own blood that is spun down to concentrate the platelets and growth factors when separated from red blood cells. Extracellular matrix is derived from pig bladder which is used traditionally for would healing. It happened to be a remarkable serendipitous observation that when used for the benefit of a hair transplant incision, the area of hair that was not transplanted which was thinning actually became thicker. For the past 3-5 years of data, Dr. Prasad has had limited need for reinjection. He has close to a 100% success rate for male pattern hair loss.

Dr. Prasad does not negate the potential of hair transplants which he does perform, but in his practice he has shifted philosophy. He has been helping a lot of his patients by not having a hair transplant but rather to do injections and see how much volume of hair is restored through this method. If they still want to transplant, then he can be more strategic. One should remember that they are dealing with a limited donor area, so by strategically restoring hair which is limited in terms of the coverage, they can actually get significant coverage by doing a non-surgical treatment through this injection. Unfortunately, hair loss is an area where a lot of predatory behaviors occur where people are offering supplements and miracle treatments and all kinds of gimmicks and gadgets that don't work. Hair Regeneration is something that has tremendous data about and Dr. Prasad thinks this person will benefit from learning more about it.

How to Determine Lateral Sweep and Other Facelift Recovery Problems with a Physical Examination
How to Determine Lateral Sweep and Other Facelift Recovery Problems with a Physical Examination

A woman is 14 months after a facelift. Before, her face looked smooth and perfect. However, things changed and he wants to know if her face has a lateral sweep.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that when evaluating a patient with any unusual appearance after a facelift, it takes more than a photo to guide someone. As a surgeon, he would advise that she meet the original surgeon who did her facelift. If everything looked very good until recently, then chances are that her surgeon will have an explanation for what happened. Every surgeon who does face lifting surgery has their own signature style and has an understanding of what their patient looks like during their procedure.

There are many reasons why someone has a relative lateral sweep. It has to do with the relaxing of every face and neck lift procedure. It is the intention as surgeons to maximize the tone of the muscle under the skin called the SMAS, or the superficial musculoaponeurotic system, as well as to redrape and trim the excess skin so that it goes on very smoothly, looks nice, natural, and does not have vectors of tension. When someone has lateral sweep tension, it can sometimes be from descent of one area of the face where it was higher and came down almost like a pleat action. It could be the resolution of swelling that was present and made the area look better before, but then the swelling went down. Changes in tissue dynamics cause this pleating. Lastly, it could also be the skin quality.

There are many different ways to look at this type of issue and in a physical exam, the surgeon would actually vertically lift different areas and feel for areas of tension and opportunity. This may be something that is amenable to fillers. It could also be amenable to minimal enhancement. Although this woman submitted a very good photo, Dr. Prasad thinks that a physical exam has to be performed. If she is comfortable with her original surgeon, then that's probably where she'll find her solution. If for any reason she isn't comfortable, then getting additional opinions is warranted. Meeting with a doctor and getting additional opinions will give her a better idea on what's going on at the 14th month point of her process.

What to Expect after Congenital Ptosis Surgery and its Possible Complications
What to Expect after Congenital Ptosis Surgery and its Possible Complications

A woman had ptosis surgery 3 weeks ago and her ptosis now is worse than before. She wants to know the reason for this.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that ptosis surgery has its own unique challenges that involve a muscle called levator muscle. In a posterior approach or behind the eyelid, there are a couple of different procedures that are applied including Mueller's resection or posterior levator resection as well as Fasanella-Servat. These are names that are technical but if somebody is first concerned about their eyelid height, it's usually associated with some degree of swelling. The physical weight of the eyelid can push the eyelid down. In addition, the healing processes of the muscle and all the other related issues that occur especially in the first one to two weeks after surgery also affect the eyelid height.

From her photo, Dr. Prasad assesses that it doesn't look like she has so much swelling, so with that factor eliminated, there may be an issue with the connection or the way the tissue is supposed to heal. It might also be because of some stitches that have been broken or some separation.

Dr. Prasad thinks that her surgeon must be at least informed of her issue. The timing of any revision surgery may be dependent on when her surgeon was informed. In Dr. Prasad's own practice, if such a thing would have happened, he would prefer to find out sooner rather than later. It's a balance of when the patient wants to be operated depending on the degree of swelling, healing and what kind of impact there is on the eyelid height. When there is a real separation before the tissue has the chance to develop scar tissue, there is actually a window of opportunity to do a revision without complications. It's not necessarily within a few days or week. There is actually enough time, but it's a matter of what the surgeon's preference is.

Dr. Prasad insists that she let her surgeon see her sooner. If there are any questions or concerns, Dr. Prasad would always tell his patients that he'd rather see them than guess what they look like. Even if they show photos or pictures from their phone, or have someone to take a picture with a camera, it's always better to see that patient. Considering that this woman had her surgery recently, Dr. Prasad thinks that meeting with her doctor would be the best thing for her to do. Also, she should get an understanding of what's going on and what would be the appropriate step to do next.

For more information, visit our website:

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

How to Tell If Slightly Uneven, Drooping Eyelids are Actually Ptosis and Require Surgery
How to Tell If Slightly Uneven, Drooping Eyelids are Actually Ptosis and Require Surgery

A woman was told that she has upper eyelid ptosis of her right eye and that it's bilateral. She wants to know what surgery would be performed to correct it.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that whenever he sees a patient with ptosis, he would ask how long the ptosis has been like that. He would also ask if it was something new or has been happening over time. A thorough history is critically important to establish the diagnosis of ptosis. If it was mentioned to the patient that they have ptosis, or if there was an incidental statement that they were never aware of, then it means that they were never bothered by it. Ptosis in itself is not a reason to do surgery unless the patient is concerned about the aesthetic appearance or if there is also a functional issue related to vision.

In order to do a proper ptosis examination and to evaluate whether a person needs one eye or both eyes done, they ultimately would need a proper ptosis physical evaluation. The eyelid muscle called the levator muscle is very sensitive and there are certain things about that muscle that makes it more complicated to deal with. This is why 99.9% of board certified plastic surgeons don't do this type of surgery and this is the domain of the oculofacial plastic surgeons.

That being said, one of the things that is tricky about ptosis is a particular physiologic basis called Hering's law that has to do with the amount of tone each eyelid receives. It's called muscle innervations or the amount of tension that muscle has. If a person lifts one eyelid, the other eyelid would actually come down. That's why during ptosis surgery, in the pre-operative photos, a person can look like one eye is low and the other eye is high. Then when a surgeon does just one side, the first side can look high and normal and the other side can be low.

A patient has to decide if they are bothered about the ptosis at all. Within the normal population, 1- 2 millimeters difference between the eyes is accepted as normal and most people don't notice it. When people notice ptosis, it is because other people tell them.

It takes several exact visits for Dr. Prasad to make a decision before he decides to move forward with a ptosis operation. When a person comes in with a relative subtle amount of ptosis, he wants to look at them at several times of the day. Maybe at the end of the day, they can be more fatigued and the ptosis is more prominent.

Dr. Prasad recommends that she meet with qualified experienced oculofacial plastic surgeons who can guide her. She should get some opinions, look at their work and get a sense of what threshold would be right for her. She submitted one photo and it's clear that there's a slight difference between the two eyes, but for Dr. Prasad it's only slight.

For more information, visit our website:

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How to Treat Baggy Eyes, and the Causes and Challenges of Treating Malar Bags
How to Treat Baggy Eyes, and the Causes and Challenges of Treating Malar Bags

A woman has malar bags as well as under eye bags. She wants to know if they can treated and the best procedure for her condition.

Dr. Amiya Prasad, an oculofacial plastic surgeon for 20 years, says that the treatment for eyebags is fairly straightforward. However, malar bags have been one of the most challenging things that anyone who works in this area has to deal with.

Under eye bags are caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse is an anatomic diagnosis where the fat pockets that are around the lower eyelids, behind the skin and the structure called the septum push forward and create a bulge. This tendency most commonly comes from a genetic pattern. In fact, Dr. Prasad has operated on 3 generations in the same family with exactly the same issue.

In order to treat lower eyelid fat prolapse especially in younger people, Dr. Prasad would routinely do a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is an approach of addressing the fat pockets from the inside of the eyelids to avoid an external incision or scar. At the same time, he is able to get the nice natural contour as if the patient never had eye bags.

On the other hand, malar bags are the result of fluid over the most prominent area of the cheek bones. They are typically associated with allergies, sinuses, smoking and genetics. The basis is that fluid tends to back-up into the cheek area and stays there. Since malar festoons or malar edema is due to fluid, surgical procedures are not really effective in making significant improvements. The patients who make the most dramatic improvements are the ones who have the worst festoons that you can directly excise them and they will look better. When they are subtle, Dr. Prasad usually doesn't do anything. But when they are a little bit more obvious, he does procedures that can soften the transition between the eyebags and the malar edema. He has done things like the use of platelet-rich plasma to try to improve circulation.

There are some doctors that really advocate lasers, but these areas are very tricky and when someone applies heat in this area, there is no guarantee that the festooning will not get worse. Dr. Prasad has not been an advocate of using laser in addressing the festoons alone. That being said, the patient can consider options such as treating underlying allergies, sinuses or advise the smoker to stop smoking. In addition, Dr. Prasad employs the use of fillers as well as platelet-rich plasma (PRP). Platelet-rich plasma is a product of the patient's own blood: the blood is drawn, spun to concentrate the healing factors, then injected into the area. This has some improvement in the skin quality as well as the circulation that can make the area look better.

For more information, visit our website at:

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How to Get Rid of Puffy Eyes and the Cause and Treatment for Under Eye Dark Circles
How to Get Rid of Puffy Eyes and the Cause and Treatment for Under Eye Dark Circles

A 42-year-old woman has puffy eyes and dark circles. She is considering eyelid surgery but wants to know other treatments for her situation.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon for 20 years, practicing in New York's Upper East Side and Garden City, Long Island, sees this type of issue everyday in his practice. The puffiness is caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that is normally around the eyes pushes forward. In some studies, it has been shown to actually increase in volume. When it pushes forward, it creates a bulge-like hernia called herniated fat. The strategy for herniated fat is to do some type of procedure to reduce, sculpt as well as reposition.

Dr. Prasad explains that there is variability in puffiness of the lower eyelids because the fat pockets are affected by fluid. Fluid may be the response of the body in situations such as allergies and sinus issues where there is some backup of fluid. Food sensitivities can cause puffiness from fluid. Lack of sleep will also cause puffiness. The type of puffiness can be about fluid as opposed to volume caused by anatomy of fat.

Dark circles under the eyes are typically a combination of genetics, ethnic pigmentation, sun exposure or environment changes, as well as the quality of the skin. The skin can be so thin that someone can see through it and see the blood vessels and the muscle underneath. Sometimes in people with cases of allergies, it will be dark called allergic shiners.

In a situation like this woman's, in the absence of a physical examination, Dr. Prasad would typically recommend a transconjunctival blepharoplasty. This involves the strategic reduction of fat pockets from the inside of the eyelid, thereby avoiding an external incision and repositioning and sculpting as appropriate. He also combines this with platelet-rich plasma (PRP) which is drawn from the patient's own blood to help accelerate the healing the process. When he deals with the dark circles under the eyes, he typically does first a platelet-rich plasma treatment under the skin to improve skin quality. He will also combine that with a procedure like fractional CO2 laser. The combination of treating the physical volume as well as the skin quality yields nice results that his patients appreciate.

The puffiness after the surgery has to do with fluid management. If it is caused by allergies or sinus problems, then they have to be treated. If it's salt intake or other foods that might cause the fluid to occur, then the patient might need to be careful about their diet.

At this point, Dr. Prasad suggests that she meet with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery and who could guide her further. The thing that he can't do in a discussion like this is a physical examination. Judging the integrity of the lower eyelid tone, the canthal tendon and the skin quality is a 3-dimensional experience so meeting with the doctor is important.


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

How to Treat Male Pattern Baldness Without a Hair Transplant
How to Treat Male Pattern Baldness Without a Hair Transplant

A 29-year-old gentleman started losing his hair when he was 21 years old. He wants to know the procedures appropriate for him

Dr. Amiya Prasad, a hair specialist, explains that male pattern loss appears to have a family history or has a tendency to run in families. From the level of progression that this gentleman has, he can predict that within a few years, he'll will have much less hair.

Dr. Prasad enumerates two drugs that are used for hair loss: finasteride and the other is minoxidil. Finasteride is a pill that is taken daily. It inhibits an enzyme called 5-alpha reductase which is responsible for the conversion of testosterone to dihydrotestosterone (DHT). It's been shown that specific men have hair follicles sensitive to the effects of dihydrotestosterone. When finasteride was introduced, a lot of men benefited. Unfortunately, there is a lot of concern about long-term sexual side-effects of finasteride. In Dr. Prasad's practice, it is more typical for men in their 20s and 30s to refuse or consider taking finasteride. The other drug is minoxidil, a topical treatment that helps prolong the presence of hair that's thinning. It is something that is applied once at night.

Traditionally, the only other alternative to these medical options is a hair transplant. Unfortunately, the reality is that a lot of younger men who have this rapid progression of hair loss, after one transplant, they need another transplant. To make matters worse, the donor area which is the area at the back of the scalp is very limited and a surgeon cannot cover the space once covered with tens of thousands of hairs with only a few thousand hairs.

In Dr. Prasad's practice, he developed a treatment called Hair Regeneration using a material called extracellular matrix by Acell combined with platelet-rich plasma and injected under the skin of the scalp. This is a onetime treatment session that has effectively stopped the progression of hair loss, reverse the thinning process and thickens thinning hair. He has approximately 3-5 years of data and close to a 100% response rate with male pattern hair loss. He is developing more protocols for more advanced hair loss in terms of later stages of procedures. This material that was originally used for wound healing is derived from pig bladder to help heal by duplication of cells. It's not by duplicating hair follicles but restoring the cells and signals necessary for the hair growth process to continue.

Dr. Prasad suggests that this gentleman consider the Hair Regeneration treatment. It has been very successful as a single treatment. Dr. Prasad follows his patients very closely by seeing them at 1 month, 3 months, 6 months and all the way to 18 months to the present time to see improvement.

For more information, visit our website:

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

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