Cheek implants vs fillers – Convenience, results, predictability

Should I go for cheek implants or fillers?
The appearance of cheek bone definition is a highly desirable characteristic of people
we see who work as models and actors.
Many people want better defined cheeks, whether their appearance is caused by genetics or
related to bone and soft tissue loss with facial aging.
I’ll discuss how I help my patients every day make the choice between options such as
cheek implants, fat grafting and injectable fillers.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
Reconstructive Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Over the course of my career, I’ve been performing facial cosmetic procedures such
as the full range of facelift procedures, cosmetic and reconstructive upper and lower
eyelid surgery, fat grafting for facial volume correction, and facial implant surgery such
cheek implants, chin implants, and tear trough implants.
I have continued to evolve my approach to helping my patients with cheek volume enhancement
focusing on some key aspects which are universally of high value to everyone I see in consultation.
Structural volumizing
These are:
Safety, Predictability, Convenience, Rapid recovery and Longevity
This led to applying knowledge and experience in facial anatomy and facial cosmetic surgery
with new techniques such as The Y Lift and applying newer longer lasting hyaluronic acid
fillers at deeper levels such as the space between the bones and muscles.
This is also referred to as Structural Volumizing This has made a significant impact on how
I counsel my patients.
There has always been an appeal to long lasting procedures such as placement of facial implants.
Cheek implant surgery involves placing these silicone implants from the inside of the mouth,
over different aspects of the cheekbone.
Patients need about a week to recover from the surgery, which I perform using local anesthesia
with LITE IV sedation.
Cheek implants
Swelling can at times be more significant and take several months to resolve.
There are certain issues which come up after patients undergo cheek implant surgery.
Sometimes, the appearance is not quite what the patient was hoping to have.
This can mean having to take the implants out which means another surgical procedure.
If the desired appearance can be created with additional placement of filler then the patient
may feel conflicted about the decision to have a quote “permanent solution” and
still need to have filler placement.
Many people focus on having maximal symmetry.
Although facial implants can be customized to try to achieve this, it’s difficult to
be certain of achieving maximal potential symmetry until full healing has been achieved.
An important variable which most people don’t appreciate until it’s explained is that
facial volume continues to change with age.
This means that bone loss, fat loss and thinning of the skin will impact the long term results.
While I do perform cheek implants, often at the same time as another surgical procedure
like facelift, I inform patients prior to the procedure if this so they understand the
limitations of facial implants.
Fat grafting for cheek volume in my opinion is not ideal to achieve the look of defined
Fat grafting is limited by unpredictability where 30 to 70 % of fat placed will disappear.
Prolonged swelling with a high likelihood of asymmetry are problems I would advocate
my patients avoid for a more predictable with minimal recovery.
My preferred volume correction procedure for the face is the use of long lasting hyaluronic
fillers like Juvederm Ultra Plus, and Juvederm Voluma.
While these fillers are commonly available to aesthetic doctors, experience and technique
matters more than the material used.
This brings us to the subject of injectable fillers.
During consultation, patients often express concern about fillers in the cheeks potentially
looking too round and doughy as seen in well known people in the media.
They also express concern about the longevity of the injectable fillers.
I explain to my patients that most practitioners including the so called celebrity doctors
place injectable fillers just below the skin surface.
This space has limited capacity to maintain the structured appearance people want.
The placement may look good when the procedure is done but the filler can’t maintain the
shape as the face moves resulting in spreading or bunching in a way that is not ideal.
The technique I employ is called Structural Volumizing.
This method is derived from applying the same principle of surgical facial implant placement
where the space being enhanced is between the bone and the overlying muscle.
Instead of placing a silicone implant in the operating room during surgery, I place thicker,
long lasting hyaluronic acid filler in my exam room in a few minutes.
This placement between the bone and the muscle helps retain the consistent shape of the bone
structure rather than an amorphous shape that can occur when filler is moving around in
the more superficial soft tissue space.
The end result is more youthful facial definition.
The procedure is performed with blunt cannulas with minimal trauma so patients can appreciate
their improvement immediately.
A significant benefit is in my ability to control the placement of small quantities
of filler at different places to maximize balance and symmetry.
Neither facial implants or fat grafting can come close to this level of customization.
It should be noted that using this Structural Volumizing technique does require more filler
material than is used in traditional superficial soft tissue placement.
By using longer lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma, the results
can last over 1 year and up to 2 years.
Procedures based on Structural Volumizing is not just limited to the cheeks.
Wherever, I would have previously considered placement of a surgical implant, I can employ
structural volumizing.
This includes the chin, jaw angle, jawline and tear trough.
This global approach to facial volume correction has actually become an alternative to surgical
facelift in some patients as well as a strategy improve appearance after facelift.
The convenience of performing Structural Volumizing as an alternative to surgery has encouraged
so many more people to have this procedure since, it’s performed in a few minutes in
an exam room and patients walk out looking and feeling more confident.
Patients typically go back to their usual activities such as work the same day or the
next day.
This has been a great advantage for people who’ve come in wanting to look good for
an event happening soon such as a wedding, birthday or reunion.
Meeting the needs for patients who are busy and want safe, predictable procedures with
minimal risk and downtime has been the inspiration which has driven my innovations throughout
my career.
From performing cosmetic eyelid surgery and facelift surgery under local anesthesia with
LITE sedation, bringing into focus the needs of different ethnic groups which require specific
approaches to cosmetic eyelid surgery and the development of a system for nonsurgical
treatment for male and female pattern hair loss, I can state that the application of
long lasting fillers using the principles of surgical implant placement is another significant
step in meeting the needs of a wide range of people in the modern world.
I hope you found this information helpful…thank you for your question.

Does Finasteride Work for Female Pattern Hair Loss

can women with hair loss benefit from finasteride?
i’m often asked in my office as well as
the comments section of my youtube
channel and other social media channels
whether women can be prescribed
finasteride to help with female pattern
hair loss
so finasteride is a dht blocker and dht
stands for
dihydrotestosterone which has been well
established as a significant factor
contributing to the progression of male
pattern hair loss
What is Finasteride
finasteride is a 5-alpha reductase
5-alpha reductase is the enzyme
responsible for the conversion of
testosterone to
or dht
a large percentage of men with male
pattern hair loss
benefit by taking finasteride every day
now finasteride has been approved for
male pattern hair loss since 1997
at this time however the fda has not
approved the use of finasteride for
women who have female pattern hair loss
Who is Dr Amiyaprasada
now some doctors are still
prescribing finasteride for women which
i understand since
there’s frustration with the limited
options to help women who are
experiencing hair loss
i’ll discuss my approach to how i help
women who suffer from female pattern
hair loss
in my practice and why i don’t prescribe
finasteride for women
i’m dr amiya prasada i’m a
board-certified cosmetic surgeon and
fellowship-trained oculofacial
plastic and reconstructive surgeon
i’ve been in practice for over 25 years
in new york city and long island
What is Trichostem Hair Regeneration
i’ve been performing hair restoration
throughout my career starting with hair
transplant surgery
then assisting that with prescription of
finasteride since fda approval in 1997.
since 2011 i’ve been helping men and
women with hair loss
with the trichostem hair regeneration
system a non-surgical treatment i
developed using extracellular matrix by
combined with platelet-rich plasma or
trichostem hair regeneration has been so
successful that i built a freestanding
center specifically for this treatment
in vienna virginia and we treat patients
from all over the world in our three
Why is Finasteride not prescribed for female pattern hair loss
speaking from the perspective of a
testosterone level and hair loss
the relationship of testosterone
dihydrotestosterone or dht and the
benefits of finasteride for men
it’s pretty clear
have much less testosterone in their
bodies compared to men and consequently
have much less
dihydrotestosterone in their system
while the exact cause of female pattern
hair loss has not been determined
the relatively small amount of
testosterone in women and consequently
makes it
for me difficult to justify using
finasteride in women
now there are some women who have pcos
or polycystic ovarian syndrome who may
have elevated testosterone levels
i’ve observed that their medical doctors
will often put them on testosterone
blocking drugs such as spironolactone
and put them on oral contraceptives to
regulate their estrogen and progesterone
Treatment for female pattern hair loss
important to also note that finasteride
ingestion by women who are of
childbearing age
can potentially result in defects in the
development of male sex organs during
pregnancy gestation
we routinely treat female pattern hair
loss successfully
with our trichostem hair regeneration
without testosterone blockers like
spironolactone or a dht blocker like
i do recommend that my patients with
female pattern hair loss
have their hormonal status monitored by
their medical doctors
with our injection based treatment alone
our female pattern hair loss patients
have benefited
from the reactivation of hair follicles
which are in a prolonged resting phase
as well as the thickening
of their thinning hair strands
trichostem hair regeneration involves
typically one to two treatment sessions
with the second session or booster
at or about 18 months after the first
typically we’ve observed additional
thickening of significant percentages of
hair after the second treatment
resulting in
more effective coverage
we’ve seen this benefit even for younger
women who have androgenetic alopecia as
well as women over 50 with hair loss
often associated with decreasing
estrogen levels
without the need for testosterone
blocking or dht blockers
in my opinion studies using finasteride
for women have limitations and
just don’t show enough evidence for me
to feel comfortable to
prescribe this drug for women who have
female pattern hair loss
i would be even more concerned about
using finasteride in premenopausal women
due to the risks to a male fetus should
a woman become pregnant while taking
we’ve consistently and successfully
treated female pattern hair loss with
the trichostem hair regeneration
with benefits typically lasting three to
five years and even longer
as i mentioned earlier hormonal status
is factored into our treatment plans
patient safety and effectiveness of
guide my approach to helping my patients
in every aspect of my practice
since 2011 we’ve treated female pattern
hair loss safely conveniently and with
consistently successful outcomes
our patients again typically receive
only one or two treatment sessions
without any additional medications and
see the benefits for a period of time
that can go over five years
i hope this information from my
experience helped you if you’re
interested in recommendations for your
individual situation
you may contact us through our websites
or call our offices to schedule a
thank you

Causes and Repair of Eyelids Drooping After Past Ptosis Surgery

My eyelids are drooping again years after ptosis surgery what can I do?
Eyelid ptosis is a term to describe the eyelid position being lower than it
should be surgery for ptosis is performed to
elevate the affected eyelid or eyelids I often see patients who’ve had previous
ptosis surgery who are frustrated with needing to have another procedure the
underlying cause of the eyelid ptosis as well as age and other factors do affect
the longevity of results after ptosis surgery I’ll discuss how I counsel my
patients who come to me for ptosis evaluation
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years I perform cosmetic and
reconstructive eyelid procedures every day in my practice this includes surgery
for under-eye bags for hooded eyes and Asian double eyelid surgery eyelid
ptosis correction surgery is essentially exclusively performed by oculoplastic or
oculofacial plastic surgeons as it is specialized surgery which is focused on
during fellowship training for surgeons who completed residency in ophthalmology
as is the case for any surgery people who come in for ptosis surgery want the
procedure to be done once and be good for the rest of their life as mentioned
earlier the underlying cause for the eyelid ptosis and other factors affect
the predictability and longevity of any ptosis procedure
eyelid ptosis is classified as either congenital meaning you were born with
this condition or acquired meaning the ptosis occurred after you were born the
type of ptosis surgery that is performed is based on the eyelid position and the
function of the muscle which lifts the eyelid and this muscle is called a
levator muscle word levator is like the word elevator without the letter e at
the beginning if someone has congenital ptosis this means that the levator
muscle did not fully develop the muscle may not contract as strongly nor will it
relax or stretch like a normal muscle imagine you can’t extend your arm fully
because your bicep can’t relax completely nor can it flex your arm
fully because your bicep muscle is under developed the goal of a ptosis procedure
is to lift the upper eyelid to a height and contour which improves appearance
and vision while still allowing the eyelid to close adequately for proper
eye protection and lubrication understanding the underlying issue with
congenital ptosis is what makes the management of congenital ptosis
challenging for example a procedure for congenital ptosis is called a levator
muscle resection in this procedure the levator muscle is shortened so the
eyelid can be elevated however since the levator muscle doesn’t relax or stretch
like a normally developed muscle the eye may not close as well after surgery this
means that although a patient may look good during surgery and initially after
surgery the eyelid can drift lower than it was initially as the tissue stretches
to allow for eye protection with normal or forced blinking another procedure for
congenital ptosis is called a frontalis sling
in this procedure the muscle which lifts the eyebrows called the frontalis muscle
is connected to the eyelid margin so your eyes open by you lifting your
eyebrows I perform this procedure when someone has moderate to severe ptosis
with minimal to no levator muscle functioning in this situation the tissue
can stretch with blinking and changes occur over time with facial aging that’s
requiring additional surgery later on although there are neurologic causes for
ptosis the most common cause for ptosis is called involution ‘el ptosis which is
essentially the tendon of the levator muscle called the levator aponeurosis
becoming thinner or detaching from the structure called the Tarsus generally
people with involution ‘el ptosis have good muscle function and correction can
be performed successfully with long term stability I routinely performed ptosis
surgery from the underside of the eyelid a muscle called Mueller’s muscle is
behind the levator muscle and for people who have mild to moderate ptosis with
good levator muscle function I’m able to get consistently good results even with
a successfully executed procedure revision surgery may be needed for under
correction or over correction I know I can speak for any experienced
oculoplastic surgeon that ptosis surgery can be very challenging to achieve
satisfactory results regardless of the surgeons technical expertise I would go
so far as to say that it’s a reflection of an oculoplastic surgeons real-world
experience to acknowledge just how complex ptosis surgery can become it’s
no wonder that no other surgical specialty is trying to compete for these
procedures during my consultation depending on the type of surgery I’m
planning to perform I explained to my patient the variables
which can affect the outcome of the proposed procedure and that there may be
a need for a plan B during surgery as well as a need for revision after
surgery I actually have my patients sit up and during surgery so I can make
adjustments to improve the likelihood of a successful outcome although eyelid
ptosis correction surgery can improve your appearance effected by aging it
cannot stop the progressive effects of aging on the eyelids and the surrounding
facial areas in addition for age-related ptosis the tendon of the levator muscle
can continue to become thinner or detach requiring additional surgery I routinely
perform ptosis correction surgery under local anesthesia with LITE IV sedation
in addition to being able to make fine adjustments with my patients sitting up
avoiding the risks and recovery from general anesthesia in my experience is
optimal for my patients if I place skin sutures I removed them in about 5 to 7
days my ptosis surgery patients usually
return to work in about a week after surgery in spite of some complexity the
results of ptosis correction surgery can last for years depending on the cause of
your ptosis and the strength of the levator muscle and other I related
anatomic and functional factors the predictability and need for additional
procedures is part of the risks of having this type of surgery it’s
important that you have a proper examination and enough time during your
consultation to understand the risks that apply to your specific ptosis
condition I hope you found this information helpful thank you for your

How lasers can help with dark circles under the eyes

Can I treat dark under eye circles with lasers?
Dark under eye circles are a very common concern and can be a frustrating issue for people
who want to do something about them. Patients who come to see me about under eye dark circles
complain that they look tired or worn down, even when they feel vibrant and energetic.
Dark circles can be caused by superficial skin discoloration, ethnic pigmentation; thin
eyelid skin revealing the underlying anatomy such as the orbicularis oculi muscle and blood
vessels; iron deposits from blood pooling under the eyes; and even post-inflammatory
hyperpigmentation, or PIH, from previous laser or other treatments. I’ll discuss how I
help people who come to my practice with dark under eye circles with lasers and other therapies.
I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial
Plastic & Reconstructive Surgeon. I’ve been in practice in Manhattan and Long Island for
over 20 years.
I specialize in all types of eyelid surgery for both primary and revision surgery. I also
perform non-surgical procedures for the eyes, including injectable filler placement, laser
and radiofrequency treatments, microneedling, and platelet-rich plasma treatment.
There are different causes of dark circles under the eyes, and more than one type of
laser can help in improving the skin. When used carefully, lasers like fractional CO2,
Nd:YAG and Erbium lasers can stimulate collagen production to improve the skin’s thickness
and make the skin healthier. By improving the relative thickness of the thin eyelid
skin, which is the thinnest skin of the body at half a millimeter, there can be some improvement
in the coverage of the underlying anatomy, which contributes to the appearance of dark
under eye circles. Depending on the type of laser and the energy delivery settings, lasers
can partially ablate the skin, or remove some of the top layer of skin to allow a new fresh
layer of skin to come in, also known as skin resurfacing. Ablation can be very helpful
if the top layer of skin or epidermis is discolored and is contributing to the perception of dark
circles. Your skin’s natural pigment is more concentrated in the junction between
the epidermis and dermis as well as the dermis itself, which is the deeper skin layer. Proper
judgment in the use of a laser device is very important since overly aggressive treatment
can have a negative effect and make the eyelid skin thinner and worsen the problem. Thinner
eyelid skin from overly aggressive laser treatment makes the eyelids crepey and creates more
wrinkles. The right amount of heat from laser or radiofrequency devices can tighten the
dermis and stimulate collagen production, which improves the appearance of wrinkles.
I’ve developed treatment strategies to minimize the risk of laser overexposure. Since the
goal is to maximally stimulate collagen production, I use non laser technology to complement the
laser induced stimulation of the skin. For example, I routinely combine laser treatment
for the lower eyelids with platelet-rich plasma, or PRP. PRP is derived from your own blood
– it’s a concentration of the wound healing and growth factors needed for tissue repair
such as when you have a cut. PRP is prepared by drawing your blood as is done for a routine
blood test, and spinning the blood in a centrifuge to concentrate the platelets to create a clear,
yellow serum. PRP stimulates collagen production, and improves blood supply and circulation
to make the eyelid skin healthier and thicker without using heat energy. I find that PRP
and laser treatment work very well together in the eye area.
Dark under eye circles are often associated with relative hollowing in areas such as the
tear trough and cheek, which creates shadows and contributes to the tired looking appearance.
This is more of a volume issue so I routinely place hyaluronic acid fillers using minimally
traumatic techniques with blunt cannulas. I find that frequently, volume correction
has the most significant impact on the appearance of dark circles. On a related note, I’ve
seen a good number of patients who came in concerned about dark under eye circles without
recognizing that they had puffy under eye bags. Puffy under eye bags, make the discoloration
aspect of dark circles more prominent and makes the shadow of relative hollowing under
the eye bags appear even darker. The optimal strategy is therefore to address the under
eye bags. I address under eye bags everyday in my practice with fillers as well as a minimally
invasive surgery called transconjunctival blepharoplasty which is done from the inside
of the lower eyelids without any incisions or sutures on the outside. This is a procedure
I perform in my office facility with local anesthesia and LITE IV sedation with minimal
swelling and bruising so our patients are able to return to work typically in 1 week
looking refreshed.
Lasers are great tools to help address under eye dark circles. It’s critical to have
a proper assessment in order to determine what the anatomic variables are which contribute
to the appearance of your dark circles. I look at this area from the inside outward,
so I look for hollowing, puffy under eye bags, vascular and muscle elements, melanin or ethnic
skin pigmentation and epidermal or superficial factors which contribute to this appearance.
As an experienced Oculofacial Plastic surgeon, I’m able to help my patients with everything
from lasers, injectable fillers, PRP and surgery for under eye bags. In the modern aesthetic
marketplace, practitioners have biases to sell procedures they can do and ignore procedures
they can’t do, essentially not looking after the patient’s best interest. I can attest
to this as patients often find themselves dissatisfied with treatments done elsewhere
and come to me for evaluation. It’s important if you are looking for a solution for dark
under eye circles that you be educated before your consultation and the doctor you have
a consultation with spend time with you and provide you with a satisfactory explanation
for the therapeutic strategy they recommend for you.
I hope you found this information helpful…thank you for your question

Causes of Delayed Hair Growth and Hair Loss After Hair Transplants

Why is my hair not growing after a hair transplant?
A lack of hair growth as well as a decrease in hair density can be very distressing for people who’ve
undergone hair transplant surgery it’s important to understand what happens to
both your existing hair and the transplanted hair after surgery I’m Dr.
Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained
oculofacial plastic and reconstructive surgeon I’ve been in practice in
Manhattan and Long Island for over 20 years I’ve been performing hair
transplant surgery throughout my career I’m also the founder of TrichoStem Hair
Regeneration Centers a non-surgical stem cell-based
treatment for male and female pattern hair loss
I developed TrichoStem Hair Regeneration from observations made from the
application of wound healing technology to improve hair transplant results since
2011 we have developed customized treatments to help people with genetic
pattern hair loss the effects scene with trichostem hair regeneration include the
reactivation of hair growth which was not growing and the thickening of
thinning hair this combination results in a significant improvement in scalp
coverage losing hair soon after a long and costly hair transplant can make
anyone worry about their decision to have the procedure and the future of
their results hair transplant surgeons are often not clear about communicating
to patients about the impact hair transplant surgery has on hair that’s
still present on the scalp as well as the transplanted hair a common cause of
hair loss soon after transplant is shock loss shock loss occurs due to several
factors including the physical trauma hair transplant surgery has on the scalp
for example if a hair transplant consists of 2,000 hair grafts surgically
being implanted into the scalp this means there are 2,000 stab incisions
made into the scalp this level of trauma causes bleeding inflammation and
potential vascular compromise throughout the scalp as a consequence native hair
and transplanted hair can shed shortly after the transplant surgery this often
means that a hair transplant patient experiencing shock loss can look like
they have even less hair after transplant than they did prior to
surgery shock loss is temporary in shock loss the hair follicle remains intact so
hair will grow with time this is one of the reasons why you need to wait up to a
year or more to see the full results of a hair transplant a not so common reason
for why hair may not appear to grow after transplant is the development of
ingrown hair grafts it’s possible for hair grafts to grow inward so their
length changes very little even after a few months in such cases the skin needs
to be just opened and the hair needs to be released to be able to grow properly
another more significant cause for hair loss after transplant is collateral loss
this occurs when hair grafts are surgically placed close to existing hair
during hair transplant surgery the needle blade or implant er can
permanently damage existing native hair follicles
unlike shock loss collateral loss is a permanent loss of native hair caused by
the trauma of hair transplant surgery surgeons often justify or rationalize
collateral loss by assuming the native hairs are thinning anyway and will
eventually be lost collateral loss is one reason why hair
transplants are generally not recommended for most cases of female
pattern hair loss we’re hairs are diffusely thinning
throughout the scalp making it more likely for collateral loss of native
hairs to occur during transplant surgery in our practice we take a different
approach to hair restoration instead of looking at thinning hairs hair that will
be lost eventually we see thinning hair as something that can be improved to the
point that the results can exceed the outcome of even hair transplant surgery
the natural density of hair is 50 to 100 hairs per square centimeter this natural
density is significantly greater than the density of transplanted hair
generally hair grafts can be transplanted at about 20 hairs per
square centimeter this is because of the blood supply needed to sustain the
viability of the hair grafts exceeding this number of grafts can result in some
or even all the hair grafts being lost by thickening the thinning hair with our
Hair Regeneration treatment the improvement in scalp coverage reduces
the area of scalp that would need hair transplant surgery since native hairs
are much closer in density than transplanted hair thickening hair
non-surgically can achieve more coverage and hair density than any transplant
procedure in fact in the right patient with significantly thinning hair the
hair regeneration treatment can exceed the density and coverage of not one but
two hair transplant surgeries Trichostem Hair Regeneration consists of
platelet-rich plasma or PRP and extracellular matrix by a cell PRP which
is a concentration of wound healing and growth factors present in your own blood
is used in combination with extracellular matrix there are doctors
using PRP alone to treat pattern hair loss although there can be some benefit
we know from experience that’s not comparable to trichostem hair
regeneration some doctors are using PRP with the standardized dose of a cell as
one of a handful of doctrines using a cell since 2011 I have been treating
patients from around the world and have achieved consistent and predictable
results with visible long-term improvement in over 99% of genetic
pattern hair loss patients both men and women each treatment is customized using
an algorithm I developed from years of experience factoring in gender age of
onset of hair loss degree of hair loss covered age and other medical therapies
being used most patients only need one treatment session for thicker hair and
fuller coverage and results can be expected to last three to five years
some patients with more advanced hair loss have a second treatment which we
called a booster at 15 to 24 months after the initial treatment at no
additional cost while the Hair Regeneration treatment is
mostly used as a standalone procedure it can be used to help people after hair
transplant surgery I found there to be an improvement in hair transplant
outcomes if I perform Hair Regeneration treatment between one to three months
after a hair transplant there appears to be a benefit to the hair grafts as well
as the native thinning hair I’ve also observed the grass to grow sooner than
they would be expected to which means that they appear to the effects of shock
loss is actually reduced the overall benefit is better scalp coverage in both
the short and long term hair transplant surgery can be very effective but there
are limitations it is important to have a strategy in place to maximize your
scalp coverage for as long as it’s genetically permissible if you’ve
experienced significant hair loss after undergoing hair transplant surgery there
may be potential benefit from stem cell-based
hair loss treatment to help you improve your final results otherwise allow one
year after hair transplant surgery to transpire and assess your final results
I hope you found this information helpful thank you for your question

Chin Fat Removal Differences of Surgical and Non-Surgical Treatments

What’s the best way to remove fat under the chin?
Many people come in to our office concerned about the appearance of the area right under
the chin often referred to as a “double chin” I’ll discuss some procedures known
to address the excess fat under the chin, and talk about my preferred approach for this
type of concern.
I’m Dr. Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
I’ve been in practice in Manhattan and Long Island for over 20 years.
I help my patients with a full range of solutions for enhancement of their facial features to
create balance and harmony.
Typical procedures include cosmetic eyelid surgery, face and neck lift surgery as well
as non surgical procedures such as structural volumizing, suture suspension, PRP, skin boosting,
lasers and radiofrequency treatment.
The double chin, which is referred to medically as submental fat, is made up of excess fat
or tissue located underneath the chin and jaw area.
It is a common problem that is frequently brought to the attention of cosmetic surgeons
and dermatologists.
In fact, a 2014 survey by the American Society for Dermatologic Surgery had 68% of respondents
call a double chin a top concern.
For some people, submental fat can be caused by weight gain, while others are simply born
with a persistent, natural “fullness” under the chin that doesn’t seem to go away
even with diet and exercise.
Another cause for submental fat has to do with aging.
As we get older, our skin loses tone and elasticity, thus causing the tissue and skin to sag and
pool under the chin.
It’s also important to remember that not all double chins are the same, and many people
who think they have double chins may actually just have conditions such as loose skin under
the neck and banding from neck muscles (platysmal bands).
There are 2 commonly performed procedures to remove excess under the chin fat.
These include a drug called Kybella and liposculpture, or facial lipo.
Kybella is a non-surgical injection that was FDA-approved in 2015 to specifically address
the fat present below the chin only, and is not for any other areas of the body.
It contains an active ingredient called deoxycholic acid which is naturally produced by the body
in the bile, and this helps reduce submental fat.
Kybella is dispensed via a series of injections directed into the submental fat, and works
by destroying subcutaneous fat cells.
Once these fat cells are destroyed, they can no longer store or accumulate fat.
While the exact number of treatments and injections are dependent on patient response, preliminary
studies show that up to 6 treatment sessions may be necessary, consisting of as many as
50 injections per treatment.
While people may prefer the term “non-surgical solution”, Kybella does come with some disadvantages.
Firstly, the sheer number of treatments and injections required make the procedure unsustainable
and quite taxing on the patient in the long run.
Secondly, results from Kybella takes some time to appear since a period of waiting is
required for the fat and inflammation to clear.
Thirdly, the results of Kybella is generally unpredictable as it is entirely dependent
on how the patient’s body responds to the treatment, how much submental fat there is,
and how well that fat is broken down and absorbed.
Liposculpture, or facial lipo, is a quick, tried-and-tested procedure for removing fat
fom under.
Anesthetic is delivered into the submental fat, then a micro-cannula attached to a syringe
is inserted and the fat is carefully and precisely sculpted.
In my practice, we do liposculpture with local anesthesia and LITE sedation which means the
patient doesn’t need to go under general anesthesia.
Though liposculpture is considered to be an invasive procedure — and it must be said
that any procedure that breaks through the barrier of the skin is technically considered
“invasive” which includes Kybella — I tend to gravitate more towards this method
since liposculpture is a proven, well-established procedure which yields consistent and highly
predictable results.
In addition, liposculpture is known to successfully work after just one session, and improvement
can be seen immediately.
We are typically able to accomplish what we set out to do within an hour of initiating
it, in contrast to Kybella which takes much more more time to get comparable resuls.
That being said, even with these procedures, it’s important to understand that not all
fat is bad.
Earlier in my career, it was encouraged as part of any procedure, whether it was face
lifting or liposuction, to aggressively reduce fat under the skin with the intention of creating
some type of trauma to the underlying skin which resulted in skin retraction.
Since then, we’ve learned that aggressive liposuction or aggressive reduction of fat
can actually make the skin look older, wrinkled and rippled.
A thin layer of fat is healthy for the skin, provides a youthful look, and is necessary
to create a smooth appearance.
Fat is also important for the quality of the skin.
In my opinion, this can be done more precisely with liposculpture as the openings of the
instrument can be directed away from the fat layer you want to preserve.
The diffusion a fat dissolving chemical cannot be controlled with this level of pecision.
After liposculpture, it’s typical to have some degree of swelling and bruising, much
of which resolves in about a week.
Submental fat or under-the-chin fat doesn’t only occur in people who are overweight.
It is often a genetic issue.
I’ve done this procedure for people who are physically fit but have this genetic tendency
to have a small amount of fat under the chin.
Ideally, a good candidate for this type of procedure is a younger person who has good
skin quality and tone, and they must have fat accumulation present in spite of being
within 10 pounds of their ideal body weight.
I cannot stress enough the importance of a proper diagnosis.
Many people assume that the problem area under the chin is only caused by excess fat.
This is not the case.
For example, the position of the hyoid bone can have a significant effect on defining
the neck angle.
The hyoid bone is located towards the front and middle of the neck, between the chin and
the thyroid cartilage.
When the hyoid bone is low, it shortens the angulation between the chin and the neck,
which causes the jawline to look less defined.
Poor definition of the under chin area can also be caused by excess skin.
Loose skin under the neck is caused by the gradual sagging of facial skin due to aging,
as well as weakening of the soft tissue layer under the skin that communicates with neck
muscles called the SMAS (superficial musculo aponeurotic system).
When the skin sags and SMAS weakens, the optimal solution is a facelift, or a face and neck
Another cause for concern under the chin is loose platysmal bands that cause cords to
form on the neck.
Platysmal bands refer to the neck muscles called the platysma that have become more
prominent or loose due to normal facial aging or surgery.
Many people have actually had liposuction of the chin done only to reveal more of the
platysmal bands, resulting in an even more undesirable appearance of the chin.
This problem is best treated with a platysmaplasty to reduce the protrusion and appearance of
these bands.
I advise for a proper diagnosis and treatment plan, meet with a cosmetic surgeon with extensive
experience in facial cosmetic procedures.
The introduction of a drug like Kybella has resulted in many non surgeons offer a so called
minimally invasive procedure when the same physician is inexperienced and unable to perform
any revision procedure if required.
It’s important for you to understand that proper diagnosis is critical to proper treatment.
Consumer focused messaging combined with limited scope physicians has created unnecessary issues,
which could have been avoided.
In my opinion, multiple injections with multiple treatment sessions which are expensive to
try and dissolve fat is far more invasive and inconvenient than my performing under
the chin liposuction with local anesthesia taking as little as 30 minutes.
I hope you found this information helpful, and thank you for your question.

Expectations after hair transplant why density and long term results are crucial factors

What can i expect after a hair transplant?
Men who undergo hair transplants are often less than satisfied with the results from their
procedure many people believe that a hair transplant can be a permanent
solution for genetic pattern hair loss particularly after having had just one
procedure I’ll discuss my approach to hair loss in men and women and how I
counsel my patients in regards to the potential impact of hair transplant
surgery in a typical individual with genetic male or female pattern hair loss
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years I’ve been performing
hair transplant surgery throughout my career I’m also the founder of
Trichostem Hair Regeneration Centers a highly effective non-surgical treatment
for genetic pattern hair loss for men and women who come to us from around the
world this treatment was developed from our application of advanced wound
healing technology to help improve the results of hair transplant surgery based
on the effects seen on thinning hair I created trichostem hair regeneration as
a standalone treatment that has effectively become a
welcomed alternative to hair transplant surgery for men and women who want to
optimally manage their thinning hair issues many people about to get a hair
transplant or who just had a hair transplant think that ongoing
progressive hair loss is effectively treated by a single hair transplant hair
transplant surgery does not treat progressive hair loss at all a hair
transplant involves harvesting hair grafts
from a permanent zone which is a band of hair at the back of the head that are
genetically resistant to hair thinning and transplanting them to an area where
hair has been lost this process does not prevent progressive thinning or future
loss of the native hairs in the scalp the initial results after a hair
transplant can show improvement however as time goes on native hair continues to
thin and without further treatment will disappear as genetically programmed this
behavior is often what leads to the appearance of visible hair plugs
we’re only transplanted hair remains after native hairs disappear there are
two challenges that every hair transplant surgeon and patient has to
deal with one achieving the appearance of natural density two maximizing the
survival of the grafts transplanted natural hair density ranges in
individuals from fifty to a hundred hairs per square centimetre with thicker
hairs providing more scalp coverage than thinner hairs to ensure graft survival
during hair transplant the number of hairs transplanted per square centimetre
is about twenty exceeding 20 grafts per square centimeter puts survival of the
hair grafts at risk as there may not be adequate blood supply to support of the
survival of too many transplanted grafts with safe hair density being limited in
each transplant session it’s important to know that it may take more than one
hair transplant procedure to get closer to natural-looking density graft
survival is perhaps the most important limiting factor in hair transplantation
there are only so many hairs in the permanent zone which can be transplanted
of the absolute number of hairs transplant
a percentage of the grafts do not grow for example a popular hair transplant
surgery such as FUE or follicular unit extraction in this procedure up to 30%
of hair grafts can be lost just from the process of harvesting which results in
something called transection or dividing the graft in a way where the
root remains behind while the hair is placed even with intact hair grafts
survival’s can be unpredictable patients have come in who have had procedures
such as mega sessions and have lost 90% of their hair grafts it is with the
intention to improve hair graft survival and donor area healing that led to the
application of advanced wound healing materials such as extracellular matrix
or Acellular matrix this did result in better graft survival and improvement in
the donor area healing it was during this time that we observed that native
hairs which were not transplanted grew thicker this hair thickening effect was
seen about a year after the transplant was performed this effect on the
existing hair inspired me to pursue the potential of a cellular matrix with PRP
for the treatment of hair loss without hair transplantation I theorized that
thickening existing hair and increasing the number of existing hairs will result
in greater hair density and volume in comparison to hair transplant surgery
over time and continues review of the results of treatment I created
algorithms to customize the treatment based on a person’s hair loss profile
and created trichostem hair regeneration when a person comes to our practice with
hair loss I determine if the hair loss management strategy is best approached
with TrichoStem Hair Regeneration or with hair transplant surgery
in practical terms if you still have a reasonable amount of thinning hair it
makes sense to use a non-surgical trichostem hair regeneration treatment
to maximize coverage before considering hair transplant surgery if the scalp for
example in the front is smooth and has been smooth for three years or longer
the likelihood of hair follicles being present is relatively low which makes
this person a better candidate for hair transplant surgery I recognized that the
overwhelming majority of patients who come in for hair transplant surgery
consultation are people with thinning hair not smooth scalp in the past hair
transplant was the only option for many people
now with TrichoStem Hair Regeneration the majority of people are satisfied
with the results and actually don’t end up getting hair transplant surgery if
you’re a candidate for hair transplant surgery and undergo the surgery what
should you expect after a hair transplant there is a period where the
grafts heal and become integrated with the skin the first week to two weeks is
characterized by multiple scabs at the sites where the hair grafts were placed
with proper care the skin heals and the scabs go away for several weeks
afterwards the scabs are gone and you can feel the short hairs sticking upward
however it’s common to experience temporary loss of the grafts as well as
native hairs this is referred to as shock loss during this period you can
actually look worse in terms of lack of hair coverage than you did before
surgery at about one year the grafts and surviving native hairs will be seen
interestingly people from around the world who’ve undergone hair transplant
surgery find us and inquire about ways to maximize the success of their surgery
I’ve found that TrichoStem Hair Regeneration can help
people who have had hair transplant done elsewhere between one to three months
after surgery in my opinion the treatment helps create an environment
under the skin which supports better hair growth if you think about the
amount of trauma to the scalp during surgery it makes sense that improvement
in blood supply and the tissue quality around the hair follicles should be
advantageous one observation I’ve made for patients who were treated within the
first three months after hair transplant is earlier hair growth than would be
expected in addition the improvement in the existing hair in terms of thickness
as well as the stimulation of native hair results in overall better coverage
essentially helping the hair transplant look better than it otherwise would have
another benefit we’ve seen for people who’ve had hair transplant in the past
is that the quality of the transplanted hair improves after TrichoStem Hair
Regeneration treatment this has been seen in people who have had their two
transplants more than ten years prior as well as people who have had multiple
hair transplant surgeries hair loss does not always require hair transplant
surgery the foundation of managing hair loss is to understand that hair
transplant is one option in a management strategy medical and non-surgical
therapy such as trichostem hair regeneration has been a successful
alternative to hair transplant surgery as well as a useful treatment before
undergoing hair transplant in addition during the first three months after hair
transplant surgery TrichoStem Hair Regeneration has even helped optimize
results after hair transplant surgery I hope you found this information helpful
thank you for your question

Loose Neck Skin important factors for treatment

What is the best procedure for creepy and loose neck skin?

When it comes to loose skin under the neck it’s important to determine what factors are
contributing to this appearance these factors include bone volume loss skin
quality skin quantity neck position and even posture with so many creams devices
sutures threads and procedures claiming to be the best solution for a loose neck
skin it can be difficult to choose the best option that’s right for you I’ll
discuss how I evaluate this area for people who come in with this concern
every day in my office I’m Dr. Amiya Prasad I’m a Board -certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years a core focus of my practice is to help people with changes
associated with facial aging we do a lot of skin and facial rejuvenation
procedures in our practice including surgical facelifts neck lifts as well as
minimally invasive and non-surgical treatments I begin with a history and
physical examination I often learned that a patient has had previous
procedures like neck liposuction and skin heating procedures the evaluation
is performed to determine skin thickness the presence or absence of excess fat
the relative skin elasticity the relative volume of excess skin the
presence or absence of platysmal bands the extent of facial bone volume loss in
particular the cheekbones the chin the jawline and jaw angle
the next skin is different from the skin of the face so it ages differently the
skin in the neck is thinner than the skin of the face and this area also
doesn’t have as many oil and sweat glands as the face in a situation of a
person in their early to mid 40s who’s had some skin laxity but not enough to
want to face or neck lifting surgery I think what is desired is better
structural definition I always explain to a patient that a young face is not a
tight face and an attractive face is not an over pulled appearance it’s really
about definition if the issue is skin quality such as texture and tone then
there are laser treatments and PRP or platelet-rich plasma which can be
helpful platelet-rich plasma is derived from your own blood and as a
concentration of the wound healing growth factors that stimulate collagen
and increase blood supply after an injury PRP improves neck skin quality
and texture by stimulating collagen and fat cells under the skin thus improving
the skin quality improving skin quality with PRP is optimal with regular
treatment so improvement can be maximized
we also employed different types of lasers including fractional co2 RB m and
D AG and q-switch laser to improve neck skin a very popular procedure now
practice is a non ablative laser toning with the Nd:YAG laser the laser was able
to selectively treat the deeper layers of skin without compromising the top
layer of skin I actually developed a protocol where I combined PRP delivery
to the skin after laser treatment to maximize the skin quality through
collagen stimulation radio frequency devices such as peleve can also help
with skin toning and tightening of the neck as well as to Indu
a similar collagen response radio frequency devices are often employed in
place of lasers for people with darker skin which includes olive Mediterranean
skin types Asian skin and people with much darker
or in the brown spectrum of skin color relative volume of skin as well as
elasticity is assessed to determine if a minimally invasive procedure called
suture suspension may be of benefit suture suspension is not a thread lift a
thread lift involves a placement of barbed sutures to try to tighten skin a
suture suspension procedure involves the placement of sutures comparable to those
used during surgery as is what’s done in surgeries such as in face and neck
lifting the suture is placed into stable tissue to allow lifting or repositioning
of loose tissue essentially it’s a deep suture placement often used in surgery
without skin removal if you’d like to address skin quantity or excess skin and
platysmal bands then some variation of a facelift face and neck lift or even a
limited neck lift is considered appropriate often laxity of the neck is
associated with laxity of the face when a patient has loose skin under their
neck I’ll show how addressing facial sagging can also address a sagging neck
we can do sometimes a short scar facelift procedure to be able to
accomplish quite a bit a procedure like this takes about two hours to do under
local anesthesia with light intravenous sedation once it’s done it tends to hold
very well and can last anywhere from five to ten years if platysmal bands are
present without excess skin in neurotoxins such as Botox Dysport and
XEOMIN can improve the appearance of those bands if there is excessive skin
and the participants are relax there are different ways to modify
the platysma surgically which is done typically during a face and necklift
procedure in our practice we do all face a neck lifting surgery under local
anesthesia with LITE IV or intravenous sedation this is as opposed to general
anesthesia which is often a disincentive for many patients considering surgery
procedures performed with local anesthesia with sedation allow for
easier recovery and allow for people to go back to work sooner a very important
concept which is missed often is the contribution of bone volume loss to neck
skin laxity particularly for people with limited laxity with a decrease in
jawline definition placement of an implant or long lasting injectable
fillers at the bone level can make a significant impact on your appearance
when the cheeks jawline and chin are more well-defined the relative
appearance of the skin under the neck becomes less significant the decision to
choose a procedure or procedures to improve the neck is dependent on proper
diagnosis and a clear understanding of the benefits of different interventions
there is a constant evolution in what we do and being able to perform the full
range of procedures from non-surgical and minimally invasive to advanced
surgical procedures or a combination has been a successful approach from my
patients in my practice I hope you found this information helpful thank you for
your question

Fat Grafting vs fillers results, predictability and convenience

Is fat grafting better than fillers?
As a facial cosmetic surgeon patients often ask me if transferring fat to the face
is a better way to treat age-related volume loss in comparison
to cosmetic fillers particularly because they like the idea of having a more permanent solution
they also perceive that using their own fat is much more natural than using commercially
available injectable fillers i’ll discuss how i counsel my patients about the choice
between fat grafting and injectable fillers in my practice I’m Dr. Amiya
Prasad. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon I’ve been in practice in Manhattan and Long Island for over 25 years
before the introduction of hyaluronic acid fillers in the US around 2005 the only fillers we had were
Zyderm and Zyplast otherwise known as collagen injections these were purely dermal fillers
which due to their origin from cows required skin testing two weeks prior to treatment in case of
allergy fat grafting was at the time the holy grail for facial volume enhancement there were so
many courses and presentations in our professional activities to improve fat grafting outcomes fat
grafting involves first harvesting fatty tissue using liposuction from areas such as the abdomen
and hips once harvested this living tissue no longer has a blood supply the fatty tissue is
processed for implantation and then placed into a new location like the cheeks using micro cannulas
one of the significant issues is the percentage of fat that actually survives this process it’s
generally accepted amongst my peers that about 30 to 70 percent of transferred fat does not survive
resulting in fat cells falling apart and inducing inflammation before being disposed of by your body
this means that there will be asymmetry and limited results after the healing process
of several months to a year has transpired some of the fatty tissue does not get completely absorbed
which results in the formation of scar tissue characterized by lumpiness and irregularities
a second procedure is often necessary to try and deal with the under correction and asymmetry of
the first procedure so the expense of typically two surgeries and a high level of unpredictability
led me to be more conservative with using fat grafting as part of a facial rejuvenation strategy
a distinction should be made about defining the aspects of facial aging which are responsible for
issues such as loss of cheek volume although facial aging is characterized by diminishing
soft tissue involving the skin and the underlying fat the most significant area of volume loss is
actually at the bone level based on this understanding the placement of fat under
the skin is actually not addressing where the most deficient area is which again is at the bone level
this is one of the reasons why someone who’s had fat grafting often looks swollen and
pillowy instead of defined and youthful a more predictable alternative to facial fat grafting
prior to the mid-2000s was the placement of facial implants such as cheek implants and chin implants
these implants are placed at the bone level and provide much more predictable improvement
in comparison to fat grafting there are risks with facial implants such as displacement
and infection as well as dissatisfaction requiring surgical removal or replacement
the introduction of hyaluronic acid fillers such as Restylane in the mid 2000s changed the way I
approached facial soft tissue deficiency as time went on thicker and longer lasting hyaluronic acid
fillers such as Juvederm Ultra Plus and Juvederm Voluma became available hyaluronic acid exists
naturally in your body such that we can place this type of filler
without having to perform skin testing prior these fillers are also easily metabolized by your body
another advantage is that hyaluronic acid fillers are reversible should there be any issue
requiring removal hyaluronic acid can be easily dissolved with an enzyme called hyaluronidase
hyaluronic acid fillers are very effective for the enhancement of soft tissue such as in the area
of the lips i routinely use thicker hyaluronic acid fillers at the bone level comparable to the
facial implant placement and I’m able to create a natural and defined look
hyaluronic acid fillers are typically placed within the skin
for wrinkles and acne scars for volume enhancement in areas such as the cheeks
fillers are conventionally placed just below the skin similar to the way fat grafting is performed
this placement can enhance projection but the nature of the filler and the intrinsically weaker
tissue below the skin results in the filler not staying where you intended but rather spreading
out and creating a softer less defined appearance in order to address the most significant cause of
volume deficiency I use specialized techniques to restore volume at the bone structure level
this is where it’s most impactful it’s because between the bone structure and the overlying
muscles is a space where an implant such as a cheek or chin implant can be placed I apply this
surgical principle for the precise placement of thicker hyaluronic acid fillers to create a result
comparable to a facial implant the significance of this technique cannot be overstated I now
routinely use hyaluronic acid fillers to enhance areas such as the jawline cheekbones and chin
in a way that previously was only possible with facial implant surgery I’m able to perform these
procedures in my exam room in about 30 minutes and my patients go out and about right afterwards
typically without any sign of having had anything done this concept we refer to as Structural
Volumizing when performed as a combination of the cheeks chin and jaw angle it’s called a Y Lift
you cannot do this type of procedure using fat
nor can you get these kinds of results using conventional filler placement techniques
i routinely see my patients after two weeks to see if any additional volume would be a benefit
surgical fat grafting for a period of time showed a lot of promise for facial volume enhancement
ultimately the lack of predictability the prolonged healing process the high frequency
of undesirable results and the need for repeated surgical procedures could not be overcome in spite
of many years of research and clinical practice optimization although the potential of longevity
is the basis for continual application of fat grafting by some of my colleagues
in my opinion this limited potential benefit has a low probability of success and does not
justify the unpredictability and significant rate of complications which have a much higher
probability of occurring in comparison time and technology has allowed me to help my patients
with an approach that is highly predictable safe and reversible without surgery this structural
volumizing with long lasting benefits using safe hyaluronic acid fillers aligns very well with
modern life which as we all know is characterized by limited time and a little tolerance
of avoidable complexity I hope you found this information helpful thank you for your question

Asymmetric Eyelids – When Surgery is recommended and when its not

Should I have surgery for my asymmetric eyelids?
Cosmetic upper eyelid surgery is often requested by people who feel they
have asymmetric upper eyelids causes for
asymmetry can include differences in bone structure the amount of skin and
fat over the eyes the eyelid height and the appearance of the eyelid crease I’ll
discuss how I evaluate patients concerned about asymmetric eyes in my
practice I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years
as a specialist in eyelid surgery I perform all types of eyelid cosmetic and
reconstructive surgeries every day in my practice including revision surgery to
correct cosmetic eyelid surgery procedures originally performed by other
doctors I also perform non-surgical eyelid procedures every day including
fillers botox PRP lasers and radiofrequency technology treatments
some people notice that their upper eyelids are slightly different in height
Eyelid Height
and expressed concern oftentimes this is something only they are aware of and
it’s not something that other people notice I explained that it is normal to
have a 1 to 2 millimeter difference in the height of the eyelids generally
unless there is a more than 2 millimeter difference in height between the two
eyelids most people looking at you don’t notice anything
if the eyelid height difference is within this normal range surgery is
usually not recommended if there is a greater than 2 millimeter difference
between the eyes one eye may be too or too high of course there are
conditions where both thighs are too low or too high or combination where one eye
eye is too high and the other eyes too low when the eyelid is lower than it
should be the term to describe his condition is eyelid ptosis eyelid ptosis
refers to two types of conditions congenital ptosis which means ptosis you
were born with and acquired ptosis which is ptosis that occurs after you were
born when a significant amount of acquired ptosis occurs a proper
eyelid ptosis
ophthalmologic and neurologic examination may be necessary to rule out
a neurologic cause for the ptosis when surgical correction of ptosis is being
considered that type of surgery I perform is based on the degree of ptosis
and a strength and function of the levator muscle which is the muscle
responsible for most of the upward movement of the eyelids I routinely
perform procedures to treat mild to moderate ptosis from the underside of
the eyelid by shortening a muscle called Mueller’s muscle I also perform
surgeries such as levator muscle advancement which is done from the front
of the eyelid through the upper eyelid crease in select situations such as
congenital ptosis with minimal to no levator muscle function I perform a
procedure called a frontalis sling where I create a connection between the eyelid
and the muscle above the eyebrows called the frontalis muscle this allows for the
action of raising the eyebrow to open the eyelid another variable which is not
bone structure
typically thought of as contributing to asymmetry is bone structure if you look
at both halves of your face you’ll notice that the face is not perfectly
symmetrical even celebrities and models who are known for their symmetrical
features do not have perfectly symmetrical faces
the cheekbones can be appreciated as being different in terms of projection
when one side of the face is compared to the other bone structure determines a
shape as well as the relationship of the eyebrows to the eyes there are times
when this variable is not fully appreciated when a surgeon performs
upper eyelid surgery which can result in upper eyelids looking hollow I often
address the situation by placement of a long-lasting hyaluronic acid filler at
the bone level to restore fullness in a way that looks more natural and
symmetric the same applies when no prior surgery is performed but the upper
eyelid area appears asymmetrically hollow because of genetics or aging the
upper eyelid skin can also look a symmetric between the two eyes in
several ways such as the amount of hooding in the relative amount of
fullness in Asian eyelid anatomy one eyelid can have multiple creases while
the other has one or no crease these situations are typically managed with
cosmetic upper eyelid surgery or upper eyelid blepharoplasty I approach these
situations with a customized strategy which is specific to the individual’s
Anatomy for example the amount of skin and fat contouring I would perform would
be different between the two eyes in a situation such as where multiple creases
in an Asian eyelid are present I would consider performing a procedure such as
a non-incisional Asian eyelid surgery to create a more stable and symmetric
eyelid crease filler placement is routinely performed in my exam rooms
with blunt cannulas resulting in minimal to no bruising and minimal swelling I
perform upper eyelid surgeries such as upper eyelid blepharoplasty and ptosis
surgery and frontalis sling using local anesthesia with LITE intravenous
sedation in some ptosis surgery procedures I have my patients sit up so
I can assess the eyelid height and shape with the patient in a natural and
upright position this approach has been easier for the
patient as they avoid the nausea and the opioid drugs used which are more
associated with general anesthesia our patients usually return to work in about
a week when the surgery is performed before deciding if upper eyelid surgery
is appropriate for your concern about symmetry it’s important to differentiate
natural and subtle asymmetry from significant asymmetry when surgery or
non-surgical options are to be undertaken the surgeons experience an
aesthetic style is critical to achieve natural-looking results eyelid surgery
particularly for the purpose of achieving maximal symmetry is very
precise to the point that millimeters really matter I hope you found this
information helpful thank you for your question