FAQ Videos: Lower Eyelid Surgery

The tear trough area is influenced by the following factors: (1) skin thickness, (2) skin color, (3) bone structure, and (4) the presence or absence of fat pockets. If there are no bulging fat pockets existing in the area, Dr. Amiya Prasad prefers to use a dermal filler, such as Restylane, alongside a dose of platelet-rich plasma (PRP), in order to correct volume and skin quality.

Eye bags occur when the fat around the eyes droops or sags, making the eyes look swollen or puffy. While there are quite a number of cosmetic products and devices that claim to be able to fix eye bags, a surgical procedure will still be needed to address serious cases. In Dr. Amiya Prasad’s practice, special attention is always given to ensure that the patient recovers well and heals fast after lower eyelid blepharoplasty.

In some cases, eyes can look tired due to droopy upper eyelids and puffy under eye bags. As a practicing cosmetic Oculofacial plastic surgeon with experience that spans over 20 years, Dr. Amiya Prasad has attended to many corrective surgery cases, restoring not only the look of the eyes but their overall condition as well.

Dr. Prasad emphasizes that surgery of the eyes has a substantial influence on the function and health of eyes, and it is important that patients seek out an experienced surgeon to do the task. It is easy to be swayed by impressive terms like “Board Certified Plastic Surgeon���; however, one must keep in mind that this alone is not suggestive of any specialized training or proficiency in the area. Dr. Prasad recommends patients to do their own research and seek out a surgeon with expertise in eye surgery, artistic skill, and wide-ranging experience.

In Dr. Amiya Prasad’s practice, blepharoplasty is performed with intravenous LITE™ IV sedation, which permits patients to experience speedier recovery periods.

Upper eyelid blepharoplasty addresses problems of the eyelid crease, as well as extra skin that may be present on the eyelids. In some cases, fat and soft tissue can be added and sculpted into the area to improve the overall appearance of the eye.

Lower eyelid blepharoplasty deals with droopy, swollen and tired-looking skin under the eyes. This procedure can be executed either from a transcutaneous approach (from the outside) or a transconjunctival approach (from the inside).

When contemplating which type of procedure to have, make sure you choose a surgeon with advanced eyelid surgery skills as lower eyelid surgery can adversely affect the lower eyelid if not done properly.

Aside from the typical risks associated with surgery, such as bleeding and infection, there are risks involved in eyelid surgery that can affect the function and health of the eyes and could lead to complications. These complications may include: (1) drooping of the upper eyelids after surgery, (2) skin shortage that prevents full eyelid closure, (3) unwanted scarring, (4) lower eyelid retraction, and (5) ectropion. Other complications may also include dry eyes and corneal ulceration.

Before having eyelid surgery, make sure to have a full proper medical and physical examination of the eyes in order to lessen the risk of complications. A full examination should include a proper diagnosis of any existing eye issues such as ptosis or lacrimal gland prolapse.

To minimize any post-operation scarring, detailed planning, a minimally traumatic surgery and immediate post-operative care are necessary. When performing lower blepharoplasty, Dr. Amiya Prasad favors the transconjunctival approach, so as not to create any external incisions on the skin. A certain level of artistry is required when addressing excess skin on the upper eyelid, as these incisions need to be positioned in such a way that even when the eyes are closed, they are scarcely noticeable. At the end of the surgery, Dr. Prasad chooses an optimal suturing technique and makes use of an advanced wound healing mixture (platelet-rich plasma or PRP), in order to speed up the healing process. This combination, along with proper home aftercare, helps patients recover quicker with less scarring.

Transconjunctival blepharoplasty is a surgical procedure that tackles the problem of puffy, tired-looking eyes without making any external incisions on the skin. Dr. Amiya Prasad prefers this method because it does not disturb the delicate muscles and ligaments that work to provide support and function for lower eyelid. In Dr. Prasad’s practice, transconjunctival blepharoplasty may be done on patients of all ages and can be combined with fractional CO2 laser treatment and platelet-rich plasma treatment (PRP) in order to reduce dark circles and fine age lines.

The end results of eyelid surgery can last for up to 5-10 years, depending on the following conditions: (1) the patient’s age at the time they had the surgery, (2) the patient’s overall health, and (3) the state of one’s skin. In order to foster realistic expectations of what surgery can do for them, Dr. Amiya Prasad strives to help his patients gain an understanding of the way the face ages over the years and how this affects the appearance of the eyes and the effects of surgery.

In preparation for eyelid surgery, patients must remember to disclose the following information to their surgeon: (1) the patient’s overall health (prevailing conditions, ailments, prescriptions or supplements) and (2) if they have or had any eye ailments such as dry eyes or blepharitis. It is important to first address these conditions before undergoing surgery in order to prevent any further complications. Keep in mind that the more detailed you are about your medical history, the more beneficial it will be for both you and your surgeon.

Although eyelid surgery is a popular type of cosmetic surgery, many people still end up with undesirable results due to poor surgery jobs. Many of these unwanted results include (1) droopy upper eyelids, (2) skin shortage that hinders the eye from closing properly, (3) lower eyelid scleral show, (4) lower eyelid retraction, and (5) ectropion.

To avoid these complications, it is extremely important to seek out the services of a surgeon who specializes in this particular type of eye surgery, as this requires a deeper and more extensive level of training and specialization. It also helps to seek out a surgeon who displays a meticulous dedication in studying your medical history and who will be committed to understanding your aesthetic goals, as well as the kind of results you want.

The best way to determine the right doctor for you is by doing research. Proper eyelid surgery is a very complex procedure that requires skills and knowledge that most general surgeons do not possess; therefore it is essential to take a look at a doctor’s training background and area of expertise. Another important value to consider is the amount of experience a doctor has, as this speaks volumes about the skills of a surgeon. As a cosmetic Oculofacial plastic surgeon with over 20 years of experience, Dr. Amiya Prasad makes it his duty to educate patients about the different aspects of eyelid surgery so they can make informed choices.

“Pulled down” eyes is a complication that is also referred to as “rounding”, “scleral show”, or lower eyelid retraction, and is quite a common occurrence in patients after having undergone blepharoplasty. The complication is caused by tissue loss, which leads to poor support of the lower eyelids. To fix this type of complication, the surgeon must examine the anatomic relationship of the patient’s eyes in order to determine an ideal position for the eyelids. Before corrective surgery can be done, proper eye lubrication must be maintained, especially for the exposed areas, to keep infection and irritation at bay.

Under eye bags are not directly influenced by sleep patterns, allergies or sinus conditions. Under eye bags are caused by lower eyelid fat prolapse, which is what occurs when the fat around the eyes becomes displaced, making the eyes look heavy-laden, tired and puffy. There are many types of creams available in the market that claim to address eye bags, however, these mostly address only the exterior quality of the skin around the eyes, and do not fix the root of the problem, which is fat prolapse.

As a practicing cosmetic Oculofacial plastic surgeon with over 20 years of experience, Dr. Amiya Prasad prefers using local anesthesia with IV sedation. This type of method puts the patient in an extremely relaxed and drowsy state, while still being conscious during the procedure. In Dr. Prasad’s experience, this type of method is less demanding on the body compared to general anesthesia wherein the patient is unconscious and placed on a respirator.

While it is true that darker skinned people can be more disposed to the formation of keloids, it may not always be the case particularly if extra precautions and attentive care is given. In an article entitled, “Ethnic Considerations in Eyelid Surgery’’ written by Dr. Amiya Prasad, he discusses that keloid formation can be prevented, especially if the attending surgeon has a good understanding of the skin type, facial anatomy and optimal placement of incisions on darker skinned people. It is advisable to seek out a surgeon with substantial experience in treating darker skinned people and who devotes the necessary time needed to fully evaluate and understand a patient’s case.

Downtime after surgery is sometimes viewed as an inconvenience, and because of this, Dr. Amiya Prasad has developed his own system that allows him to treat patients quickly and effectively, with minimal downtime. All surgical procedures are done in his own licensed operating facilities, with the attendance of a dedicated team of nurses who he regularly works with. In Dr. Prasad’s experience, having a consistent team contributes to quicker and smoother surgery procedures. After the surgery is completed, speedy aftercare is given in the recovery room. This immediate attentive care given to the patient after surgery plays a substantial role in how fast a patient recuperates. Because of this, they are typically able to return to work within 1 week.

As a practicing Oculofacial plastic surgeon that was also initially trained as an eye surgeon, Dr. Amiya Prasad frequently comes across dry eye cases. Patients must keep in mind that before having eye surgery, they must be examined in order to gauge the optimum position of the lower eyelid to facilitate better lubrication of the eyes. In the past, Dr. Prasad has effectively performed successful eyelid surgery on severe dry eye cases, and even on patients with Sjogrens syndrome, rheumatoid arthritis and thyroid eye disease.

Creams cannot fix the problem of under eye bags, as they do not address the root of the cause, which is lower eyelid fat prolapse. The most they can do is improve the quality, texture and color of the skin around the eyes. The best way to fully correct eye bags is by having surgery and sculpting or repositioning the displaced fat layer under the skin.

Blepharoplasty can only address wrinkles around the eye area that is part of the skin that is removed during the procedure. However, depending on the type of wrinkles, there may be other options to remove them as well. Static wrinkles, which are wrinkles that are present on the face even without muscle activity, can be removed with the help of platelet-rich plasma (PRP) or a microfractional CO2 laser. Dynamic wrinkles, which are wrinkles that appear when the facial muscles move to show expressions, can be addressed with the help of Botox® or Dysport.

The goal in treating under eye wrinkles is to increase the amount of collagen under the skin. Often times, a patient’s go-to solution for this is to undergo thermal stimulation of the skin. Because the skin under the eyes is particularly thin and sensitive, the heat treatment must be adjusted to suit the individual. In his practice, Dr. Amiya Prasad opts to use the microfractional CO2 laser on lighter skinned patients, and the Pellevé radiofrequency treatment on darker skinned patients. To further help boost the collagen formation; platelet-rich plasma (PRP) is also given alongside the treatment.

The success of ptosis surgery relies on the following elements:
(1) The type of surgery
(2) If other surgeries are performed together with it
(3) The type of anesthesia
(4) The surgical team
(5) The surgical technique
(6) The post-operative recovery process

In his practice, Dr. Amiya Prasad prefers to use local anesthesia with intravenous sedation. He developed his own sedation technique which lets patients wake up feeling refreshed, without experiencing long downtime periods or grogginess that is characteristic of general anesthesia.

In order to make sure that his surgical team is efficient, Dr. Prasad makes sure each member of his staff is practiced and highly proficient in any given situation that they may encounter during a procedure. Furthermore, he performs surgeries in his own Joint Commission-accredited operating facilities, which makes it much more convenient and contributes to a better recovery experience for his patients.

With regard to surgical techniques, Dr. Prasad asserts that technical skill, experience and an artistic eye are all essential in his line of work. Having significant exposure to many cases helps a surgeon to make more accurate decisions and enables him to react well to different scenarios.

Lastly, Dr. Prasad favors enhancing the recovery process, and he does this by making sure that there is enough support staff to attend to the needs of every patient upon completion of their surgery. With this type of attentive care, most people are able to work after 5-7 days.

Eyelid surgery is accomplished by surgeons of several specialties. However, over the years financial interests have sparked a lot of inter-specialty competition and disputes, wherein one group of surgeons claims to be better over another.

With over 20 years of experience, oculofacial plastic surgeon Dr. Amiya Prasad regularly performs advanced corrective surgery on people from all over the world. Oftentimes, these people have already had surgery done by “board-certified” surgeons of several specialties. It is important to stress that within every specialty performing eyelid surgery, there will be inconsistency in the surgeon’s technical abilities, artistry, proficiency and experience.

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

Eyelid lifts are done to address extra skin and fat around the eyelids. Blepharoplasty is a surgical procedure performed on the upper and lower eyelids to address extra skin, fat, and other structural issues. A patient may decide to undergo either an upper or lower eyelid blepharoplasty, or both. Ptosis surgery is a surgical procedure specifically performed to fix the position of the eyelid margin relative to the pupil. Other procedures may also include levator muscle advancement, levator resection, and frontalis sling.

Transconjunctival blepharoplasty is a surgical procedure performed through the inside of the eyelid in order to address puffy under eye bags. A beneficial feature this technique offers is that it leaves no scarring or tell-tale marks that you’ve had cosmetic surgery done, since the incision is made on the inside of the eyelid. Another beneficial feature of this technique is that a person’s natural eye shape is better preserved.

Blepharoplasty refers to upper and lower eyelid surgery wherein the main goal is to improve the appearance and function of the eyes, and to sculpt extra skin and protruding fat pockets around the eyes.

As practicing oculofacial plastic surgeon with 20 years of experience, Dr. Amiya Prasad firmly asserts the importance of performing blepharoplasty with a profound understanding of eye health, as well as having the technical expertise to successfully accomplish the goals of the surgery.

Many of Dr. Prasad’s patients come to him to get revision surgery for surgeries that were improperly done by other surgeons. He treats patients in his Joint Commission-certified operating facilities, typically using local anesthesia with intravenous or IV sedation. Most of his patients are able to return to work within a week without experiencing much discomfort during the healing process.

Complications that can occur during or after a blepharoplasty procedure may include the following:
(1) Excessive bleeding
(2) Infection
(3) Undesirable scarring
(4) Vision loss
(5) Double vision

The issue of excess skin and displaced fat pockets around the eyes are not considered “complications” but “enhancements���. Dr. Amiya Prasad often receives patients seeking corrective surgery to fix bad results from an earlier surgery done by a different surgeon. One of the most recurrent reasons why people seek out revision surgery is to address retraction after lower eyelid surgery. This is a complication wherein the eyes become irritated because areas that were once protected and covered are suddenly exposed. It is best to evaluate these complications with your surgeon in order to determine how to manage them.