Prasad Cosmetic Surgery

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Micro Fractional CO2

Micro Fractional CO2 Laser Skin Resurfacing

The Micro Fractional CO2 Laser technology is particularly effective for treatment of skin conditions such as fine and coarse wrinkles, raised or unsightly scars (such as from acne), dilated pores, uneven pigmentation and sun damaged skin. Developed during 25 years of scientific research, the technology uses a beam of mixed light that is filtered through CO2 and isolates specific wavelengths that comes into contact with the outer layer of skin. The light beam heats and vaporizes the skin tissue and instantly removes superficial layers, scars and wrinkles while smoothing out the surface of the skin. The resultant remodeling in the deeper layers stimulates new collagen growth which yields firmer and more glowing skin.

Dr. Amiya Prasad Explains MiXto SX Micro Fractional CO2 Laser Treatment

For his practice, Dr. Prasad has selected the MiXto SX Micro Fractional CO2 Laser as it best suits busy New Yorkers who want healthy, younger looking skin with minimal discomfort in a short period of time. The MiXto SX Fractional CO2 Laser uses a computerized pattern generator and a new, efficient scanning algorithm (program) so that heat is dispersed within the epidermis(superficial skin layer) while evenly treating damaged areas. This particular algorithm effectively reduces discomfort, the need for anesthesia, and recovery time. A single treatment can show dramatic improvement in skin texture and color and leave it smooth, firm and even-toned.

Click here for transcript.

Question No. 5- November 13

When I Smile or Squint, The Thin Skin Under My Eyes Puffs Up into Wrinkly Bags. What Are my Options?

Thank you for your question. You’re asking what to do about wrinkly skin that becomes very wrinkly and puffy when you smile. Now this is a very common issue in my practice, especially people with lighter skin. You know, the eyelid skin is the thinnest skin in the body and that means that the skin being half millimeter in thickness is easily affected by a lot of factors including sun exposure, being one of the biggest ones, smoking, even hydration can really affect the delicate skin under the eyes. So based on the photos you submitted, what I notice to you was that even if your skin is relaxed, when your face is relaxed, there are lines that are there. Now those lines in our field, we refer to those as static lines. And then, when you smile, those wrinkles and lines become more accentuated, and those are referred to as dynamic lines.

One of the biggest mistakes people has made, and as a specialist in the eye area, I have seen so many people who went to a doctor to have the skin removed with the misperception that there was excess skin. And so when they removed the skin, because when they smiled it bunched up so much, if their face was relaxed, their eyelid pulled down and it’s a problem called lower eyelid retraction. So I’m not going to advise you to have cosmetic eyelid surgery necessarily. Essentially, the approach that I would consider is to treat the skin so that it improves in skin quality.

Now how do we do that? This is a half millimeter thick skin so there’s only so much you can do. But in my practice, I routinely use lasers, such as my fractional CO2 laser and I combine it with the use of platelet- rich plasma. Now this is a very leading edge procedure where we actually draw your own blood and we spin it and concentrate the factors that are responsible for healing. And what that does is, it stimulates the body’s own collagen and it basically improves the skin texture as well as stimulating blood supply, and so the skin becomes healthier. So, if you were to have platelet- rich plasma and the laser, that’s one aspect of this.

Now, years ago, I actually made a point to recommend combining these treatments where we try to smooth out the skin with Botox or Dysport. And the reason is we want to reduce the activity of muscles that will cost the wrinkling to occur during that time when the skin is healing. So, I think that combining something like Botox or Dysport to reduce the activity of the muscle and then using a procedure or a combination of procedures to smooth out the skin, I think will help. I don’t think that it will completely eliminate it because as long as you’re moving and smiling, you’re going to have some of that bunching. But I think this will be a good way to help prevent things from getting worse and improve the current situation. I hope that was helpful and thank you for your question.


The Micro Fractional CO2 Laser Treatment may be combined with other facial procedures such as a facelift, eyelift, rhinoplasty, or browlift. It can be a remarkable achievement to be able to do this single treatment procedure with a facelift. With Micro Fractional CO2 Laser, the whole face may be treated at the same time.


Click here for transcript.

You asked:

What Can I Do About my Under Eye Bags and Lines?




Thank you for your question!


The question you submitted was about under eyebags and lines.


Well, as an oculofacial cosmetic surgeon, this is probably the most question I get all day long and every day of my practice. And it’s because really that puffy eyes and lines under the eyes are one of the first things to happen to a lot of people when they start showing some signs of aging or just having some hereditary puffiness under the eyes. So let’s understand first what the bags are.


If you’ve done any research, you’ve learned that the puffy bags under the eyes are actually fat pockets. And these are fat pockets that are inside the eyelid that are behind and they push forward. And why they push forward is generally a genetic trait. In other words, if these bags run in the family or there are members in the family who have them, there’s a very good chance that you have them as well. A lot of my patients, in my 20 years of practice, I’ve actually operated on three generations in the same family many times. So the genetic component is a real factor.


So the thing that a lot of our patients do before they come and see us is they first try to treat the puffy bags by using over the counter creams and all kinds of lotions that are guaranteed to help and of course, they don’t work. And that is because the problem is called lower eyelid fat prolapse where the fat pushed forward and there’s not topical cream that can help that area.


Now earlier in my practice, I used to treat the puffy bags as an isolated procedure because people came in with the concern about puffy bags. And as soon as the bags were gone and the eyelid were healed, they were of course concerned about the lines and wrinkles. So my approach is first indentify the different components and you’ve recognized the fine lines under the eyes. And a lot of times when people have puffy eyelid surgery or transconjunctival blepharoplasty which is what I would do typically in my practice. And that’s a procedure where we take out the fat pockets from the inside of the eyelid. I would actually combine that with a procedure that helps the fine lines and wrinkles basically to comprehensively enhance and rejuvenate the eye area.


Now the tools we have for this are typically a laser, specifically a fractional CO2 laser which helps to stimulate new collagen and to restore almost like a baby quality smooth skin with this fractional laser technology. We also do something interesting called platelet rich plasma and we use platelet rich plasma which is derived from your own blood like a typical blood draw when you go to the doctor or the lab for a blood test and we concentrate the platelets which are part of the blood that are important for clotting and healing. And we’ve learned that it actually helps with collagen remodeling and building and improvement in areas such as fine lines and wrinkles. We also use it for acne scars and in fact we actually use platelet rich plasma in combination with ACell in our hairloss division in our practice. So this combination of addressing the puffiness and treating the lines at the same time as a procedure is a very nice way for our patients to look brighter and that’s the key is that when you do a procedure like this, and you reduce those two key elements that makes the eyes look tired, it makes you look a lot brighter very often a lot younger.


So to summarize the recommendations for your concerns, transconjunctival blepharoplasty which means removing the fat bags from under the eyes and combining that with fractional CO2 laser and platelet rich plasma will be typical in my practice. The only thing that I can’t do is do a physical exam to understand the quality of your skin and the other anatomic aspects of your eyelid. So I hope that was helpful and thank you for your question.





The MiXto SX Laser has been very successful in helping patients who are not ready for a facelift. Since the laser rejuvenates by improving the tone and luster of the skin, it can refresh the face by leveling out small to medium sized wrinkles. For patients who have had already had a facelift within the past few years, this laser treatment is a great way to obtain a refreshed look without having another surgical procedure. Another very important application of laser therapy is to rejuvenate the hands to match the rejuvenated face.

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

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