Prasad Cosmetic Surgery

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Transconjunctival Blepharoplasty

Transconjunctival Blepharoplasty – a Freshened Look (Without Signs of Surgery)

Eyelid surgery, or blepharoplasty, consistently ranks as one of the most popular facial cosmetic surgery procedure in the US. Its popularity can be attributed to the significant improvement in your appearance when the “tired” look is addressed:

- Transconjunctival blepharoplasty( lower eyelid surgery), is performed without any external incisions. When expertly executed, eyes look completely natural without any visible sign of surgery such as scars or an over-pulled look. Even an ophthalmologist  would find it difficult to see the evidence of surgery when performing an eye exam.

- The cause of puffy eye bags is the naturally occurring fat pockets around the eyes pushing forwarded and creating a bulge (AKA lower eyelid fat prolapse, or herniated fat). Since these enlarged fat pockets are underneath the skin, they cannot be treated with topical treatments like creams, lotions, or ointments.

 - While use of non-surgical fillers can temporarily treat select cases of puffy eyes through camouflaging the bulges of fat. These fillers are temporary and in many situations, the bruising from fillers may last longer than the minimal bruising  seen in Dr. Prasad’s surgery. Fillers are often used by non surgical doctors which make eye bags appear even larger.

-  The eyes convey emotion and non-verbal communication. Weary-looking eyes can often convey the wrong feeling or message.

- Remarks about looking tired, weary, and lacking energy are based primarily on the appearance of eyelid skin. Comments about “looking tired” even when well-rested is the most common complaint of patients inquiring about eyelid procedures.

- The problem of puffy or enlarged under eye bags is mainly a genetic issue, and often not age related. This means that younger patients, as early as in their teens, can be candidates for lower eyelid blepharoplasty, with transconjunctival blepharoplasty likely the most appropriate option. Click here for transcript.

Under Eye Bags at 20? I have bad eye bags under my eyes. My Mother also suffers from this but she didn’t develop her bags until she was in her late 30′s. It’s worse when I smile obviously and it looks horrible under normal lights. It’s worse on one side which the side I sleep on. Am I a good candidate for surgery or injections I also look tired and I have been suffering with this since I was 16. Any advice would be appreciated. Thank you. Thank you for your question. You are asking is it essentially normal to have eye bags at the age of 20, and that you described in your question that your mother got eye bags when she was in her thirties. Well, you are definitely on the right track because eyebags typically are genetic, and they do cause people to have them as early as their teen years. In fact, in our own practice we’ve had a patient who was 14-years-old, and had such big bags under his eyes, he was being teased at school. And so we went ahead and did the lower eye bags and helped him literally change his life because he was being teased for being on drugs because of the bags under his eyes. So essentially you know that you have bags under the eyes, so what I’m going to do is essentially is clear up the cause of those bags. Not the genetic cause, but rather what it is anatomically. And those bags represent something that is caused lower eyelid fat prolapse. And what that means is that there is fat that is normally around the eyes, and at various times in people’s lives based on a combination of genetics and some other environmental factors such as smoking and allergies, these fat pockets can push forward. Sometimes they are referred to as herniated fat or fat prolapse. So, when you have puffiness under your eyes like that, that automatically makes you look like you’re tired. And so people often come to me and often use the phrase that they’re tired or looking tired. So what I do for someone who is younger and doesn’t have excess skin under their eyes, I will do a procedure called transconjunctival blepharoplasty. What that means is that the fat pockets are addressed from the inside of the eyelids. And if you do your research you will see a lot of people who claim to do something called fat preserving and fat transposition and these other terminologies, septal tightening. And in many ways the lower eyelid blepharoplasty approach has become in some ways similar to the way that people talk about facelifting procedures, where some people claim deep is better than not so deep, and things like that. As an expert in this area, I perform all these techniques, and I customize them to the patient’s needs. But the important thing to remember is that if you have this procedure done from the inside of the eyelid, there is no outside scar, and that’s a really big advantage. And so the rest of it is art and finesse, and that’s where choosing a surgeon who is very familiar and in my opinion at the expert level of performing eyelid surgery, such that all the techniques are familiar to the doctor. There are other things to help in skin quality and texture, and in my practice we will sometimes address those at the same time as the procedure, and sometimes more often we will address the skin issues as an ongoing management and maintenance so that people’s eyes look fresh and healthy for as long as they want to have them look their best.
– When compared to other facial surgical procedures, eyelid surgery, especially lower eyelid surgery (lower blepharoplasty) is the among the quickest, least costly, and fastest healing procedures – even stitches are not required.

 Enhance the Look of Your Eyes with Transconjunctival Laser

Transconjunctival Blepharoplasty

Transconjunctival blepharoplasty is a type of eyelift surgery often performed on people of ethnic backgrounds. It is used to remove the appearance of bags and loose skin under the eyes.

Transconjunctival blepharoplasty is a type of eyelift surgery often performed on people of ethnic backgrounds. It is used to remove the appearance of bags and loose skin under the eyes. These conditions are due to bulging fat deposits in the lower eyelids. Dr. Prasad uses transconjunctival laser blepharoplasty to remove, sculpt and reduce the fat. This procedure is internal, producing no outside scars and preserving the natural shape of the eye. This 53-year-old Latina lady was accustomed to always looking young forfce the appearance of her eyes. Frustrated with applying makeup to hide the bags under her eyes, she came to Dr. Prasad and underwent lower eyelid transconjunctival blepharoplasty. She appreciated Dr. Prasad’s familiarity with the concerns of African-American people in terms of scars and keloids.

Click here for transcript.

You asked:

Transconjunctival Eye Bag Removal or Non-incisional Laser Eye bag Procedure? I’m 22 and plagued with serious genetic dark circles and eye bags, along with very dry lower eyelid area, which has made me look very old. I’m looking to undergo an eye bag removal procedure and have heard of the transconjunctival eye bag removal where the incision is on the inner surface of lower eyelid, and another method which uses laser instead of cutting. I would be really grateful if I could be given some advices and insight which would be more appropriate for my situation. Many thanks. Thank you for your question! By the nature of your question, I think it is important for you to understand the anatomy and the process of dealing with under eye bags. You asked about a transconjunctival approach and you also asked a non-incisional laser approach. So let’s begin first with anatomy. Puffy under the eyes is caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse is representation of fat pockets underneath the eyes that have pushed forward and created a bulge. Now, I’ve been a surgeon for 20 years, specializing in many things in oculofacial plastic and reconstructive surgery. I’ve have seen a lot of things and going back to a more traditional way including non-incisional approaches in reducing puffy bags. People have tried to create little openings in the skin and try to heat things up on the outside. So understanding that it’s a fat pocket that it’s like a hernia. There is no non-incisional way to do the procedure. But the procedure is to get to the area of the fat pocket, reduce the fat pockets, reposition or do a combination of the two. When you asked about a laser, basically a laser such as a CO2 laser is a tool used to make an incision. You see, in our practice, we use CO2 lasers as well as radio frequency technology and we do it because we want to minimize bleeding. The beauty of using an incision instrument that reduces bleeding results to a cleaning field for the surgeon to be able to work as well as lesser bruising for the patient. So no matter what approach you do, whether you choose to have a doctor do it using a radiofrequency or a laser, there’s till going to be an incision. So what I would probably do for someone like yourself and this is one more thing that you have to learn about is that I would do the transconjunctival approach and I would use my laser or radiofrequency. Typically, they’re almost equivalent. And I would also, to help with the skin quality and the dark circles, I would use something called Platelet-rich plasma. Now Platelet-rich plasma is taking advantage of the healing properties of your blood using cells called platelets. Now these cells can separated from the plasma by a process we call centrifugation which means spinning the blood until it is separated. And with this centrifugation, we are able to get the part of the blood that has platelet-rich plasma and inject it. And so routinely I would do this and I find that my patients have an improvement in the quality of the skin and the appearance of their dark circles. Very often dark circles are genetic. You can’t get rid of everything but when there is inflammatory and environment components for example, someone who applies a lot of make-up use astringents to rub that make-up off tends to make the skin quality more delicate and dry-looking. So helping them with Platelet-rich plasma helps them to have a nice difference. So, I want you to understand that regardless of the technique, there is still an incision. There is a matter of how to do it and finding the right doctor that works for you who is very experienced in cosmetic eyelid surgery through the transconjunctival approach and maybe consider the other option of the use of platelet-rich plasma to help enhance your result. So I hope that clarifies your question and I wish you the best of luck. Thank you for your question!

Dr. Prasad’s Transconjunctival Blepharoplasty Procedure

Dr. Prasad performs transconjunctival blepharoplasty under local anesthesia with LITE IV sedation (twilight anesthesia), allowing a quicker recovery time. During the procedure, the lower eyelid is approached from the inside and the fat pockets are sculpted and repositioned. Dr. Prasad evaluates the results throughout the procedure to make sure that the shape and contour of the eyes are as desired. If needed, Dr. Prasad may also tighten any loose skin after the fat is removed. This process usually involves the use of lasers such as the fractional CO2 laser and does not usually require stitches, and downtime is minimal.

Cosmetic Oculoplastic/Oculofacial Plastic Surgeon –  Super-Specialist and Artistry for the Eye Area

Dr. Amiya Prasad has the rare specialty among cosmetic surgeons titled as an oculoplastic/oculofacial surgeon. This super-specialty of being an Oculofacial surgeon (ophthalmic plastic and reconstructive surgeon) involves being trained as a facial cosmetic surgeon as well as an ophthalmologist. This expertise, along with Dr. Prasad’s artistic and natural aesthetic style, has made him a sought after eyelid specialist in New York and around the world.

Being an oculofacial plastic surgeon has also brought patients who had their eyelid surgery done elsewhere to Dr. Prasad for revision and correction. Patients who have had too much eyelid skin removed by other doctors, resulting in drooping eyes, or worse having eyelids with impaired function, come from all over the world to have their eyelids reconstructed by Dr. Prasad.

Click here for transcript.

You asked:

Is This Lower Lid Retraction After Lower Blepharoplasty? I’m 30 days post op from an Endoscopic brow lift and lower Blepharoplasty. My lower lids seem to be drooping down on the outer edges. My right eye is more prominent than the left. The doctor has me doing rolling massage three times a day. I’m devastated by the outcome but I haven’t expressed concern about this with my Dr. yet. I meet him again in two weeks. What is this and should I call him sooner? Also, is it normal not to have feeling from the top of my head to my brow? I’m 50 and a nonsmoker. Thank you for your question. You’re 30 days after endoscopic brow lifting lower eyelid blepharoplasty and you’re asking about eyelid retraction. And you’ve describe one eye being worsen than the other and your doctor has advised you to massage the lower eyelid and you’ve also expressed that you are devastated that you haven’t expressed this with your doctor so clearly you’re looking for additional opinion and some guidance. Well, first of all, being in communication with your doctor so critically important. Your doctor obviously set out the procedure the best way the doctor knows how and is following up with you in 2 weeks so you are getting, in my perspective, the appropriate attention that you will need to deal with the concerns that you have. The question with numbness after endoscopic brow lift is a reasonable question is not at all unusual to have numbness so you are clear with that. There are nerves in the forehead specifically that provide innervations or sensation to the skin although eyebrow and the scalp and swelling can really have an impact on that. And so typically, I tell my patients that this is narrowly common endoscopic brow lift and also face lifting. In face lifting there is a region of numbness in smaller and smaller as time goes on. So as far as the lower eyelid retraction is concerned, as a cosmetic ocular facial plastic surgeon, who specializes in eyelid complications and revision surgery, I have lot of experience with lid retraction. When people come to me and as early as someone like you have, I would generally, if there is no clear indication medically to pursue revisional procedure, then conservative management is usually the first line of treatment. The conservative management includes massage. You see when lower eyelids is performed, sometimes the eyelid can look relatively retracted but not because of complication or healing complication but rather swelling that causes the muscles of the lower eyelid called the orbicularis muscle to be having a little bit less tone so there is a relative sag. Sometimes I describe the lower eyelid as a hammock and this hammock when its loose can get sag so if your doctor noticed or physical examination that your lower eyelid is tight or pulled down, then massage can help that. Now there are exceptions to this. We have had many patients who come to us whose eyelids where so pulled down that their eyes are exposed or the outer core of the eyelid was not connected and they were not only having overriding of the eyelid where the eyelid was irritating. The upper eyelid was riding under the lower eyelid and the eyelid was getting irritated and also the eyelid was also away in the eye that it was causing a lot of ophthalmic issues. And in any time there is an issue that is potentially vision threatening or ocular health threatening then we do things more aggressively. So it seems your doctor is in the right track of management. Now when things settle, you may feel that your eyelid is retracted more than you want and then revisional procedure maybe indicated so it is very important that you continue to communicate with your doctor now, one knows anatomy of your eyelid better than the surgeon who operated on you assuming that the surgeon also did a proper preoperative assessment. Understanding that there are definitely times when in the best in hands procedures may need some kinds of revision procedure that your surgeon will work with you and do whatever enhancement is necessary if its indicated. So at this point I would say you best option is to still work with your doctor and see where the eyelid goes and as your healing process continues. So I wish you the best of luck, I hope that was helpful and thank you for your question.

Local Anesthesia with LITE anesthesia for Faster Healing, Recovery, and Reduced Risk

Dr. Prasad is a pioneer in performing eyelid surgery such as transconjunctival blepharoplasty with local anesthesia with IV sedation. Using local anesthesia with IV sedation means that patients do not have to have general anesthesia. The advantage of this technique is that patients recover from surgery faster, shorten surgery time, have less bruising, and without the possible complications associated with general anesthesia (being unconscious and breathing through a respirator). Dr. Prasad trademarked his Quick Recovery technique using LITE™ IV sedation – a combination of local anesthesia with IV sedation to relax the patient during the procedure.

Click here for transcript.

You asked:

Filler under Eyes VS Lower Blepharoplasty? I am a 32-year-old female and looking for the best treatment for under eye hollows/wrinkles. I went to a dermatologist to discuss fillers. To my surprise, she recommended a lower blepharoplasty instead of fillers. With work, surgery really isn’t an option. Is there ANY filler that will treat under eye hollows/ wrinkles? If so, is it better to inject them into the cheeks or tear troughs? Doctor: Thank you for your question! You’re submitted question with some information about your age, 32, and having the puffiness under your eyes and visiting a dermatologist about addressing the puffiness non-surgically. I’m actually impressed that the dermatologist recommended that you have a blepharoplasty all though based on your work schedule it might not be practical. And the reason I say this is, in my area in the upper east side of Manhattan in New York City and in Garden City, Long Island, there’s lots of non-surgical physicians who are trying to address under eye bags by adding volume. Unfortunately, a lot of these efforts are very misguided and there’s a reason for this Anatomically, facial aging, I actually wrote a book called “The Fine Art of Looking Younger” is a couple of different processes and one of them is volume loss. However, the tissue as we get older also gets thin so trying to fill tissue that’s thin with volume that compensates the loss of bone, muscle and fat makes a lot of people in our area look very strange and look very amorphous. In fact, a significant number of patients come to our office every week looking to have the filler, typically Restylane and Juvederm that’s placed in their tear trough, removed with the use of an enzyme called hyaluronidase in order to stop their bags from looking even worse because when you they add in the volumes, everything swells. Concerning the relative hollow that you are perceiving, clearly there’s puffiness under your eyes and that puffiness is called lower eyelid fat prolapse. And the lower eyelid fat prolapse means that the fat that’s normally behind the eye pushes forward and creates a hill. Very often people interpret it as a hollow is actually this contrast between this high hill that makes the valley of the tear trough look deep. Now when I do an evaluation of the eye area for someone who’s concerned about it, I always look at the eye and the cheek because there is a real relationship between the aesthetics of the eye that’s also related to the cheek area. So adding a filler to the cheek area may soften the area of contrast between the eyelid and the cheek. However, I would suggest that you meet with an experienced cosmetic surgeon who does a lot of eyelid surgery and ask about techniques and methods to allow for quick recovery. And I’ll tell you from my practice and my experience, one of the first things I did 20 years ago when I went into practice is I was determined to help people who were coming to me that were basically aging baby bloomers who don’t have time to recover to get back to normal life as quickly as possible. So I developed a particular style and process of doing eyelid surgery that we could basically call a quick recovery approach. And what that means is, very often for the right candidate, we can do a procedure on a Thursday or even on a Friday and reduce the puffy bags under the eyes and allow them to get back into work on Monday. So essentially, we use the weekend as a big part of the healing process and then where we’ll make-up their under eyes for work. And then day by day, a little bit of fluid and swelling resolves and nobody knows what’s going on and you’ll look better. So, I don’t think you should completely take out the option of having surgery because there are techniques that do exist to allow people to recover quicker and that not only includes the surgical technique but also the anesthesia and the after care. So I think that’s a good place to focus your energies as a way to soften this area probably because the puffiness is so significant that this dermatologist and I think any doctor who understands that softening the tear trough a little bit would probably would not make enough of a difference and in compensating the puffiness may make the eyes extra puffy. So you may want to save your money and wait for the right time to do the lower eyelid surgery first and maybe combine it something to addressing the eyelid cheek hollowing in the future. So I hope that was helpful and thank you for your question.

Transconjunctival Blepharoplasty for Older Patients

While most surgeons believe transconjunctival blepharoplasty is only appropriate for younger patients with no excess eyelid skin, it can also be appropriate for older patients. Older patients with large eye bags also fear that once fat is removed, the skin would droop and sag.

The orbicularis oculi muscle in the lower eyelid acts like a belt, and can tighten lower eyelid skin once fat has been removed. This muscle can be active in older patients – even when a considerable amount of fat has been removed, the orbicularis muscle can tighten the loose skin.

Eye bags Before and After older 2Eye bags Before and After older 1

Click here for transcript.

You asked:

Would I Be a Candidate to Have Bags Removed from Under Both Eyes at my Age (66)? Also, will they return, once removed? Can anything be done for upper eyelid droop? Doctor: Thank you for your question! Are you a candidate for removal of bags at the age of 66? Well, based on the photos you submitted, the answer is yes, you are a very good candidate for the reduction of bags under the eyes at the age of 66. And the key for you is having a sound strategy by learning about your options and so hopefully, from my reflection of the photos you submitted that it’ll help guide you in making a decision. Well, at this stage of your life, it’s clear that you have light skin, you have some fine lines and some wrinkles and that there’s a lot of puffiness under the eyes. Well, when you do some consultations about lower eyelid blepharoplasty, you’re going to be given a few different choices as far as the ideal and every surgeon comes to the table with their preferences. As a cosmetic oculofacial plastic surgeon, been practicing for 20 years, I want to stress to you a couple of key elements in making the right choice when you finally decide to have the lower eyelids treated. First of all, at this stage of your life, it would not be surprising to me if you have any issues with dry eyes. Now, even if your eyes are watery all the time, it is very common for people to have dry eyes and have reflexive tearing. So, what’s important to really understand is that lower eyelid position is critically important particularly as we get older in order to get proper lubrication of the eyes. When people have dry eyes, foreign body sensation and other problems, then aesthetics becomes secondary. In my practice, 20 percent of my practice is revision eyelid surgery and people come to us from all around the world with one particularly common problem and that problem is lower eyelid retraction. Now, this is not to scare you but at least to give you some guidelines to understand what the anatomy is and how, making the choice you’re going to make, can affect the anatomy. So what does this all mean? Well, the lower eyelid sits against the eye like a hammock. And it has some key structures that need to be supported. When any type of eyelid surgery is performed, it can affect the underlying structure and support of the eyelid. And when that happens, the surgeon who is proactive and skilled and anticipates these issues can very often, 9 out of 10 times, do procedures to prevent these problems from happening. There is some percentage of people who have healing issues and can still have problems. But, the key is to actually anticipate. So, when you look at the choice of having this procedure, the options are going to be a Transcutaneous approach which means from the outside, underneath the eyelashes, and a transconjunctival approach which mean going from the inside. I can’t make a one recommendation over another without doing an examination. When I evaluate a patient, I look at the eyelid tone. I look at the strength of the lateral canthal tendon, I look at the skin elasticity, and those things that we can’t do with reviewing a photo. But just to be aware, when you go for your consultation, ask about issues related to the eyes pulling down or retracting and see how the cosmetic surgeon answers your questions. Someone who really understands the eye and the function should be able to help you to really understand what the options are. I tell you that, in my practice, when someone comes to me their 60’s, very often there is looseness or laxity of the canthal tendon so I have to do some kind of canthoplasty or canthopexy type of procedure in order to support the eyelid. I look to see whether or not the skin has elasticity. Very often, the skin can be wrinkled at the same time very stiff and when the skin is very stiff, it’s prone to pull downward. So, a lot of plastic surgeon will, in the attempt to remove wrinkles and improve skin smoothness, will remove skin and cause the eyelids to pull down. So, unfortunately, there are a few minds out there of doing eyelid surgery. So I would suggest that you do a few consultations, meet with people who have extensive experience in cosmetic eyelid surgery and are able to handle various level of complexity and complications should they occur. So again, to summarize, you are a good candidate to reduce the puffiness under your eyes. I’m just cautioning you to consider the impact of the procedure on the eye health and choose the best surgeon for you. I hope that was helpful for you and thank you for your question.

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

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