Prasad Cosmetic Surgery

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Lower Eyelift


A Pelleve treatment will treat those fine lines and wrinkles with immediate ssmoothing effects to your skin with this non-invasive skin tightening method. You'll love the look and feel after your PRASAD Pelleve treatment.

Lower Eyelid Plastic Surgery by Dr. Prasad in New York

Blepharoplasty (eyelift surgery) of the lower eyelids is performed to address puffy bags under the eyes, loose skin and sagging tissue supporting the lower eyelids. Very often people seek lower eyelid plastic surgery because their lower lids look droopy and tired due to one or several of these problems.

(Click on image below to view more before and after photos of Lower Eyelid Lifts)
Lower Eyelift Surgery New York Before and After Causes of Tired-Looking Lower Eyelids

  • Bags – Bags under the eyes are often misinterpreted as bags from fatigue or allergy. The bags that are seen under the eyes, that remain despite sleep and appropriate allergy treatment, are due to fat prolapse. The eye sits in a space called the orbit. The fat that prolapses is referred to as orbital fat. To improve the appearance of the bags under the eyes, the fat may be removed, sculpted and reduced through one of two approaches. The two most common approaches are external (transcutaneous) and internal (transconjunctival). Traditionally, bags have been approached by a majority of practitioners through an external incision. Depending on a person’s age and ethnicity, the preferred method that Dr. Prasad uses is the internal approach, also known as transconjunctival blepharoplasty. Through the internal approach, there are no outside scars, and the shape of the eye is typically more well-preserved. In the transcutaneous approach, an incision is made directly below the eyelashes to access the fat by lifting up the skin and going through the orbicularis oculi muscle to get to the fat pads.
  • Click here for transcript.

    What Are my Best Options to “Depuff” my Lower Eyelids?

    Hello. I am 26 and have always been insecure of my bags! I’ve had them as long as I can remember. My father is Turkish and has large under eye bags. Anyway, mine are a little different: they are extremely puffy when I wake up or cry-and most of the time the swelling slowly goes down a little. I was reading into fillers under the eyes but am worried how you would know how much to put in since they are not always the consistent with the fluid in my eyes.

    Thank you for your question… You are asking what’s the best way to depuff your eye bags and your description is very clear about what the things that make the eye bags worse. So, to answer question about de-puffing your eye bags, we first have to answer what’s causing the eyes to look puffy, and very commonly people assume it’s fluid, it’s from salt intake, it’s from allergies and although those are factors that can affect puffiness under the eyes, most of factors are temporary. So if your eyes are puffy all the time and regardless of your diet salt intake or whether you’re crying or anything else, then based on the photos you submitted, the most likely thing you have is called lower eyelid pat prolapse. What –what is that mean? Well, fat prolapse means that there is a normal amount of fat around the eyes that are part of the natural anatomy and when they push forward it’s called lower eyelid fat herniation or fat prolapseand when that happens your eyes are puffy all the time.

    Now unfortunately people find themselves first buying all the creams they can find, and going to every drugstore or following the wisdom of infomercials and other things like that. But the fact is, when your eyes are puffy like that, it is because of what’s going on inside or behind the skin. So any treatment on the outside really isn’t going to do much.

    So, to restore your appearance, there have also been other options such as the use of injectables, but the problem with the injectables when someone has significant amount of puffiness under the eyes is that, the puffiness is still there and blending it almost make the eyes puffier as a way of passed a certain point. In our practice, we will use injectables when there is a slight amount of puffiness.

    So in your case, the best solution to de-puff your eyes is called lower eyelid blepharoplasty. Now as strange as it may sound for someone who is young, I can share with you that the youngest person in my practice to have done surgery to help with fat puffiness was actually fourteen years old, and this young man was becoming very withdrawn because at school he was being accused of using drugs because he had bags under his eyes. So, when you have puffiness under the eyes and it runs in the family then in my practice I would perform, especially someone who is young, a procedure called transconjunctival blepharoplasty. Now what that means is, I can actually treat the puffiness and the puff packet from the inside of the eyelid. This way you avoid any incision or any scar on the outside. By the doing this you are able to really not let anybody know that you had a procedure. Even your eye Doctor will have a hard time figuring out that you had a procedure like this.

    Now there are various techniques and there is where it’s a generic procedure. As an eyelid specialist, I have done thousands of these surgeries and there’s a lot of finesse in a ways this is done. Some people talk about fact transposition, septo tightening and essentially a skilled cosmetic surgeon is able to employ any of those procedures in order to restore a natural appearance to your eyes. So what I would recommend for you is to consider having this procedure, do your research and identify a qualified cosmetic surgeon who has extensive experience in the eye area, and think you’ll be very happy into getting rid of the bags into your eye or to depuff them.

    I hope that was helpful and thank you for your question.

  • Loose Skin – Many people are concerned that after the bags are removed from under the eyes, there will be loose skin. Depending on the support of the lower eyelids, loose skin can be removed at the same time. This can be done when the fat pockets are removed with transconjunctival lower eyelid plastic surgery. Loose skin can also be removed when the approach to the lower eyelids is from the outside completely.

    Click here for transcript.

    You asked:

    Best Way to Refresh Eyes After Lower Bleph (S. CA Expert)?

    I had a lower bleph in 2007. Now I’m 34 and look much older than my years around the eyes. I have darkness and deep set wrinkles (under and at crows feet) especially when I smile. I’m looking for treatment suggestions (from lasers to surgery) and recommendations for Doctors who have extensive practice with this area in the S. CA area. Any advice would be great and would love to do a consult. Thanks!


    Thank you for your question!

    Regarding how to deal with wrinkles after eyebag surgery is clearly one of the most common issues that we deal with our practice every day. Having the procedure in ’07 and as you can see your skin continues to age and you’re dealing with some wrinkles. I’ll tell you a little bit about my approach to my initial consultation with anyone who has bags as well as wrinkles as well as the ongoing treatment of wrinkles under the eyes.

    First of all, it’s important to understand when people consider blepharoplasty that the puffiness can sometimes artificially make the wrinkles look more smoother. It’s kind of when someone is obese, their skin can look smooth, they really don’t look healthy but their skin can look like they don’t have wrinkles. In isolation they look younger.

    So when you are dealing with fine lines and wrinkles under the eyes, my approach depends on a couple of factors. One is the skin type. So for your skin type, light skin, skin that maybe sensitive to the sun, I go to a couple of key procedure. We first go to a procedure which is a fractional C02 laser. Now, the fractional C02 laser is a laser that is based on a principle of applying thermal energy to the backbone of the skin called the dermis so that new skin or new collagen is generated. And by doing that, there’s actually some contraction and flattening of the skin or smoothing of the skin so the wrinkles become less deep. It’s important to understand that the goal is not to get porcelain flat skin. Regardless of how smooth your skin is at rest, when you smile, there will be some wrinkling.

    So now, in addition to the fractional C02 laser, we employ a technique of application called platelet-rich plasma. Now platelet-rich plasma is getting very popular as procedures such as vampire facial or vampire facelift procedures are getting well known thanks to some celebrities. And what it actually mean is, we actually draw blood like a typical blood draw that you’d have for your doctor visit or going for routine labs, and we spin down the blood to isolate platelets. Now this part of the blood which is used for healing actually work very well in our practice for the treatment of wrinkles, fine lines, acne scars, small pox scars, things like that when we want to generate collagen. What’s nice also is that the platelet-rich plasma stimulates blood supply to the area something that fillers can’t really do. So a typical patient like you would actually, in my practice, I would use a combination of platelet-rich plasma and fractional C02.

    Last in this equation is to diminish the depth of the wrinkles by the activity of a muscle. And that muscle is called the orbicularis oculi muscle. This is the muscle that when you smile, it causes the wrinkles to form. And so, I would use botox or dysport to relax the muscle so that as time goes on, the skin does not wrinkle continuously and cause this creasing effect. So these are my typical go to procedures.

    In addition to these other procedures, let’s say you had some fine lines and you didn’t have the down time available to you, we actually use a radio frequency device called pelleve. Now pelleve is a non-surgical radio frequency technology using frequency and the skin is heated at the level of the dermis similar to the CO2 laser. Unlike the CO2 laser, we don’t have to penetrate the skin so you can come in and have the treatment and have no sign that you had anything done. And like the C02 laser, the skin generates collagen to help improve the quality of the wrinkles.

    So, in summary, the options and combinations, for me the combinations are always better than the treatments at the individual basis. So fraction CO2 laser, platelet-rich plasma, dysport or botox as well as pelleve are options to help the fine lines under the eyes.

    I hope that was helpful and thank you for your question!

  • Eyelid Support - One of the most common reasons people are referred to Dr. Prasad has to do with unrecognized problems with lower eyelid support. Properly supporting the lower eyelids requires several different specialized techniques. In addition, the support structures of the eyelid can be shaped in a way that can create a brighter appearance to the eyes.

    Click here for transcript.

    You asked:

    Unhappy with Blepharoplasty. Drooping and Pulling Down of Lower Lids?

    I am now 18 months post blepharoplasty and am not entirely happy with the results. The scars have healed with a definite drooping and pulling down of the lower lids, one side more so than the other (and despite taping for 6 weeks post surgery and massage). Is another surgery the only way to rectify this?




    Thank you for your question!


    The problem that you are concerned about with your eyelids pulling down and you’re now 18 months after your lower eyelid blepharoplasty and your question of course is, is surgery the only way to address this. Well, as an cosmetic oculofacial plastic surgeon, this happens to be one of the most common reason why people come to me for revision surgery. Lower eyelids being pulled down is much more common after cosmetic eyelid surgery than a lot of people are aware of. The people that tend to come to me are the ones for whom whose had significant droop that one or two additional procedures were attempted ad they still needed revision. So what I’ll explain to you, and it’s necessarily specific to your issue but it does have some relevance in terms to the principles.


    The lower eyelid is a much more complex structure than people understand. Even plastic surgeons, facial plastic surgeons don’t always appreciate the complexity or have all the tools to repair something a situation like yours.


    So just to understand the anatomy, the lower eyelid is like a suspension bridge. And the outer aspect of the lower eyelid has to be suspended from a solid location. And that solid location is called a lateral orbital rim and the structure is called a lateral canthal tendon. And it’s where the lower eyelid attaches to the bone. That’s a very critical element.


    When people come to our practice who have this issue, a lot of times, they’ve had plastic surgeons pull the skin up and try to attach the skin to the skin adjacent to the upper eyelid or to the muscle or other soft tissue structures and invariably, it just pulls down further. They’ve even tried things such as mid-face lifting in order to try to recruit skin and everything to get the lower eyelid up. The other aspects of the anatomy have to do with the amount of skin in the lower eyelid. It sometimes necessary and I’m not saying that this is right for you but sometimes we need to do skin grafting in order to restore the amount of skin because there’s skin shortage. And the probably the least understood concept happens to be the pillars that are necessary to vertically hold-up the lower eyelid. Again, like the pillars on a bridge, you have to have something from the rim of the eye, that space to the lower part of the backbone of the eyelid in order to keep the eyelid in a vertical position. So again, speaking from a lot of experience, a lot of people they got small pinches and tucks but the center of the eyelid or the rest of the eyelid tends to sag like a hammock because it’s not supported in those areas in terms of the pillars.


    So revision eyelid surgery to help you be happy about your appearance appears to be indicated. However to determine the type of surgery that you need, you need to have a proper examination. When I see patients for this type of issue, I do a couple of things. I examine the outer corner to see how much I am able to lift without too much stress or resistance. I pull the lower eyelid upward in order to see how much skin and again how tight things are and then we come up with a game plan. Sometimes it’s something as minimal as a procedure called a lateral tarsal strip or lateral canthal plasty or something more extensive such as drill hole canthopexy and grafting and other things that are not necessary to discuss in this response. But I recommend that you see specialists who are of course see first your cosmetic surgeon who performed the surgery for you. If you’re doctor is comfortable and familiar with this type of revision surgery, I think it’s always preferable that the doctor who did your surgery who know your anatomy and understands what was done prior is the first choice. If the doctor is not confident and you don’t feel the sense of certainty of the doctor’s ability to get you back to where you want to be, then seeking a specialist who has extensive experience with revision lower eyelid surgery and sometimes referred to as lower eyelid retraction or scleral show or terms like that then get some opinion on what is ideal for you. So I hope that was helpful for you and I wish you the best of luck and thank you for your question!




Prasad Cosmetic Surgery
61 E 66th St. New York CityNY10021 USA 
 • 212-265-8877

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