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What does Botox do?

Botulinum toxin most commonly known by the popular brand name

Botox is well known in the aesthetic field yet at the same time there was a lot of confusion about what Botox can do for example patients have asked me if Botox is an alternative to surgery or can it completely make deep lines completely disappear

I’ll help you understand what botulinum toxin like Botox can do for your appearance and how I use it 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 New York City and Long Island for over 25 years as an oculoplastic surgeon my specialty was amongst the first doctors to use Botox for issues like facial muscle spasms so I’ve been treating patients with botulinum toxin since 1993 once FDA approval for cosmetic use occurred in 2002 the popularity of Botox skyrocketed to where it is today

So exactly what is Botox or other brands of botulinum toxins such as Dysport Xeomin and Jeuveau they’re all categorized as neurotoxins and have different chemical structures which fall under the category of botulinum toxin a neurotoxin like botulinum toxin

When injected into muscles inhibits or limits muscle movement temporarily by blocking signals from nerves to the muscle it takes about three days for botulinum toxin to take effect with the peak effect being in about two weeks

These effects can last for three to six months it’s important to understand that what is injected is a liquid that affects muscle movement this is in contrast to a filler such as hyaluronic acid which is not a neurotoxin but it’s rather a gel used to enhance some volume wherever it’s placed hyaluronic acid fillers have the unique advantage in that they can be dissolved with an enzyme called hyaluronidase should the need arise botulinum toxin cannot be reversed you have to allow for a few months to transpire before the effects wear off with this particular constraint in mind

In my practice I started with more conservative dosing and have my patients come back in two weeks to evaluate their appearance if additional botulinum toxin is needed

I strategically place more at that time I make note of this for future treatments one principle behind the use of botulinum toxin is to reduce the activity of certain muscles which actively contribute to the formation of deep lines for example an area that can be treated with botulinum toxin are the crow’s feet lines located at the outer aspects of the eyes these lines result from contraction of a muscle called the orbicularis oculi muscle by inhibiting movement of this muscle there isn’t as much creasing in the skin which can cause the deep wrinkles to be primarily formed since the eyes are so important to your appearance my patients often ask about crow’s feet lines wrinkles and discolorations which remain visibly significant after botulinum toxin treatment

This is because the wrinkles and discolorations are the result of deficiencies in the skin quality resulting from causes such as aging sun exposure and smoking my approach to these problems is to customize a strategy to improve the backbone of the skin called the dermis and the surface of the skin called the epidermis for example I use platelet-rich plasma or PRP which is derived from your own blood for benefits of the healing and growth factors that stimulate collagen production and improve your skin’s blood supply

I use different lasers to resurface the skin which refreshes the epidermis as well as radiofrequency technology to help tighten the skin another area where deep lines can be improved by reducing muscle activity is the number 11 lines located between the eyes and on top of the nose these are also called frown lines or glabellar lines which is more of a medical term

These lines have a particularly significant effect on how people perceive you very often people with deep glabellar lines appear to look like they’re upset or angry by injecting botulinum toxin into the procerus and corrugator muscles muscle activity is reduced and these vertical creases become less visible horizontal forehead lines also form due to repetitive use of the frontalis muscle which is responsible for raising the eyebrows

These lines often accompany glabella or frown lines the frontalis muscle lifts the brows and the corrugator and procerus muscles move the brows in and downward since these are opposing muscles the key to satisfactory result is to reduce the horizontal forehead lines while preventing the brows from dropping too far downwards in addition to the reduction of lines formed by muscle activity botulinum toxin can be used for enhancement of different areas of the face by balancing muscle activity with muscle relaxation for example I use botulinum toxin for a procedure called a non-surgical brow lift

I achieved this by relaxing the muscles that pull the brows downward which are referred to as brow depressors these brow depressor muscles include the corrugator procerus and orbicularis oculi muscles by relaxing the brow depressor muscles that pull down the brows with botulinum toxin the muscles that lift the eyebrows in the forehead called the frontalis muscle work unopposed thereby raising the eyebrows botulinum toxin can be used to enhance the appearance around the mouth and lips vertical lip lines above the upper lip also called smoker lines are associated with the activity of a muscle called the orbicularis oris muscle this muscle is used when puckering kissing and in activities like drinking from a straw the depth and appearance of vertical lip lines can be improved

When the lips are puckered by using botulinum toxin to limit the activity of the orbicularis Oris muscle for vertical lip lines that are present when the lips are not in motion a laser procedure can be used to resurface and tighten the skin and improve the appearance of those static lines the downward position of the outer corners of the mouth often seen with the facial aging can be improved by relaxing muscles which pull the outer corners downward called the depressor anguli oris muscles when I treat these muscles with botulinum toxin the muscles pulling the outer corners of the mouth downward work unopposed and so they lift the outer corners of the mouth resulting in a lift that creates a more pleasant expression the upper lip can sometimes almost disappear with smiling

I can strategically place botulinum toxin and make the upper lip more visible when smiling I refer to this procedure as a lip flip some people feel that too much of their gums are seen when they’re smiling

This can be partially due to excess activity of the muscles that lift the lips this is often referred to as a gummy smile I treat the muscle group that lifts the lips to levator labii and the levator labii superioris alaque nasi muscles and I do that with botulinum toxin so the lips don’t elevate as much when smiling and making the gums therefore less exposed a facial imbalance due to the widening of the is associated with thickening of a muscle called the masseter muscle

The masseter muscle is used for chewing and moving the jaw an enlarged masseter muscle occurs frequently with teeth clenching or teeth grinding I inject the masseter muscles with botulinum toxin to reduce the muscle activity that contributes to this enlargement of the masseter muscle over time with consistent treatment the muscle size diminishes and the facial balance is improved multiple small dimples in the chin which is often referred to as an orange peel skin or cobblestone

It can also be treated with botulinum toxin this dimpling is caused by the mentalis muscle often seen with aging the bone loss also contributes to this hyperactivity and greater visibility of the mentalis muscle action on the skin’s surface by reducing the activity of the mentalis muscle with botulinum toxin and the skin dimpling or cobblestone appearance improves

Often combine this with the placement of long lasting hyaluronic acid filler to add projection to the chin and further smoothen the skin surface botulinum toxin particularly the brand Botox has become a worldwide cultural symbol for the natural integration of medical aesthetic procedures into the daily life of anyone who wants to improve their appearance a consequence of this ubiquity has led to a lot of aggressive retailing and misinformation in particular inappropriately minimizing the risks of botulinum toxin injection consumers are being incentivized to self-diagnose and visit any given botulinum toxin dispenser

Some of the most vulnerable consumers fall into two categories one people who don’t have the means or don’t want to spend the time and money necessary to see a higher level specialist for more comprehensive guidance as to the value of botulinum toxin for their particular concerns and number two people in their 20s who are being overly influenced into undergoing botulinum toxin and other procedures which they really just don’t need both of these groups fall victim to transaction driven lower cost physicians and non-physicians who have financial incentives to sell as much as possible to anyone who walks into their shop

Unlike more established higher level physicians with practices and reputations these people are less concerned about the long-term consequences of what they’re doing to the people who they treat I continuously see patients who come in to see me after spending more money and losing time from work after being improperly treated by these medical retailers botulinum toxin like lasers and fillers is one tool in the toolbox of potential solutions for your aesthetic concerns the art is knowing how to use botulinum toxin optimally as well as when not to use it I help a lot of successful people who come to my practice from around the world for their aesthetic needs one aspect of being successful is that they understand how to leverage their time and resources to maximize certainty in everything they do caveat emptor

I hope you found this information helpful thank you for your question

Hello my name is Mira and I had the surgery 10 days ago and it’s incredible

I’m fitting in the size 2 and look at my jeans that were standing like that before but now it’s big and for me most amazing thing is that next day I was amped now I’m walking running and it’s only 10 days my stomach looks great and I really have hourglass figure and I’m grateful to dr. I couldn’t it’s beyond my comprehension that somebody expecting expecting lots of pain and suffering and it turned out to be really i would call piece of cake surgery so i don’t know where there is i know Dr. is number one number two or technology whether their laser use but whatever it is it’s fantastic ten days later i’m working full time from a 50 and look at my jeans that’s looks great looks great very good I’m 62 remember thank you

Sometime after I had otoplasty, my ears became prominent again. Why?

Otoplasty or ear correction surgery can be a life changing procedure for people who have been self-conscious about their prominent ears.

Sometimes people are find that a few months after having their ears pinned back with surgery, their ear position regresses, and looks prominent again.

This can be frustrating, after investing time in undergoing the procedure and recovery , not mention the expense.

In my experience, the probability of significant regression of prominent ears after surgery can be minimized through choices made by the surgeon as to procedures which will be most effective toward achieving long term stability.

I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic Surgeon.

I’ve been in practice in Manhattan and Long Island for over 20 years.

I have been performing cosmetic ear surgeries throughout my career.

Ear aesthetics often come up during consultations for facelift surgery such as prominent ears, elongated or enlarged earlobes.

In addition, I see patients routinely for earlobe deformities after facelift surgery such as “pixie ear” deformity.

In addition, since many people travel to ur office for procedures form around the world, I’ve always focused on procedures with highly predictable outcomes with maximal longevity.

In order to understand why some people experience regression of their otoplasty procedure, it’s important to understand the of analysis of the different aspects of the ear which contribute to ear prominence and the appropriate procedures which would be indicated based on the analysis.

This doesn’t mean that some regression can occur with appropriately performed surgery.

In addition enhancements may be necessary since the healing process can impact the final appearance.

When I look at the ear, I divide it into upper, middle and lower thirds.

The upper third can be prominent because of underdevelopment of an area called the antihelical fold.

The middle third is an area called the conchal bowl.

Prominence in this area can be due to a condition called conchal bowl hypertrophy.

Last is the lower third which is the earlobe.

Planning ear surgery involves taking several measurements which guide the choices as to the types of surgery to be performed.

For example, for absence or limited development of the antihelical fold, surgery is performed to weaken the ear cartilage and place permanent sutures called Mustarde’ sutures.

Sometimes a suture can break and needs to be replace or the cartilage may regress partially due to something called cartilage memory.

This term cartilage memory refers to the limited elasticity of ear cartilage and tendency of the cartilage to return towards its original shape.

In my experience, this particular issue is relevant in management of the middle third of the ear, which when prominent is due to conchal bowl hypertrophy.

This basically means there is too much cartilage present which is pushing the ear more outward than is desirable.

I generally perform removal or resection of part of this cartilage.

Some surgeons prefer to use sutures to pull this cartilage toward the scalp which in my opinion can result in higher likelihood of regression due to cartilage memory.

Lastly, position of the earlobe can be corrected by some skin removal which is very effective in improving the position of the earlobe without any issue related to cartilage.

As mentioned earlier, some drift in position of the ears can occur related to the healing process.

As long as there is no obvious asymmetry, most patients are satisfied, particularly when they see their preop photos in comparison.

In my opinion the appearance of prominent ears can be improved with detailed planning and choosing the procedures which are most likely to result in stability in the long term.

During consultation, its important for you as a prospective patient to understand these concepts before moving forward with surgery.

I hope you found this information helpful…thank you for your question.

When is a surgical neck lift needed?

The neck is an area particularly prone to aging changes specifically the neck skin is thinner than facial skin and it has fewer oil and sweat glands than the face people concerned about the appearance of their aging neck often ask me when a surgical neck lift would be appropriate

I’ll discuss the different ways aging affects the neck different treatments to improve the neck appearance and when a surgical neck lift is worth considering.

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 New York City and Long Island for over 25 years

I routinely perform surgical neck lifts often in combination with facelift surgery such as deep plane facelift i also perform procedures for neck enhancement such as platysmaplasty for prominent neck bands as well as minimally invasive neck procedures such as suture suspension

In addition we also do non-surgical neck treatments to improve skin quality and volume in the neck area generally surgical neck lifting is for sagging skin in the neck area there are several neck procedures that can be done to improve neck sagging for people with less advanced sagging neck skin prior to any neck procedure i perform an examination of the neck and specifically look at things such as neck skin thickness the absence or presence of fat below the skin the amount of excess neck skin if any the elasticity of the neck skin and the presence and absence of platysmal bands

I also look at facial volume loss particularly in the areas of the cheekbones chin jawline and jaw angle if the neck skin has thinned and the skin quality is reduced but there isn’t a significant amount of sagging surgical neck lift is generally not indicated what can be done is to improve the quality and thickness of the neck skin with non-surgical procedures a treatment to improve skin thickness and quality by stimulating the body to generate collagen is the application of platelet-rich plasma or PRP platelet-rich plasma is made up of the concentration of wound healing and growth factors that exist naturally in your blood

We prepare PRP with a blood draw similar to what you would have done in a routine lab test PRP is prepared by spinning the blood in a centrifuge to concentrate the platelets into a yellow serum when PRP is delivered into the neck skin these wound healing and growth factors can help thicken the skin and improve skin quality texture and appearance for the neck

I often combine PRP with hyaluronic acid and use a device which creates micro channels into the skin we call this procedure Skin Boosting unlike with microneedling

Skin Boosting there’s no bleeding and requires no downtime skin laxity with excess fat can also be treated not surgically for example we use a long pulsed 1064 YAG laser to deliver heat in a way that results in fat reduction and skin tightening simultaneously

This procedure takes from 10 to 30 minutes to do and there is no downtime patients come for sessions depending on their individual situation people who come for neck enhancement are often unaware of how facial aging can affect the neck appearance one of the first signs of facial aging before their significant skin laxity and descent is facial volume loss this is defined as loss of volume affecting the bone muscle fat and soft tissue in particular volume loss in the chin area can cause a loss of forward projection which can cause the appearance of sagging neck skin

An important concept to understand is that the jawline cheekbone and chin are all pillars which support the face and neck skin this means that enhancing the volume of these three strategic areas can improve the appearance of the neck particularly below the chin this bone volume enhancement is called Structural Volumizing which is performed using long-lasting hyaluronic acid fillers with the technique derived from facial implant surgery this procedure is performed routinely in an exam room with local anesthesia and typically without any bruising situations where there is laxity that is too much to treat with laser-based tissue heating can be treated with a minimally invasive surgical procedure called suture suspension neck lift

It’s important to distinguish suture suspension from a thread lift a thread lift is the passing of barbed sutures in an attempt to build collagen in the skin to create a tightening effect which is minimal at best

When I perform a suture suspension procedure I’m using some of the same sutures i would employ in an open surgical neck lift and engage the sagging neck skin and anchor the sagging skin to a deeper bone level a lot of my patients come in concerned about the appearance of their neck bands also known as platysmal bands the platysma muscle is a long vertical muscle which originates from the clavicle and extends up the neck when you’re younger the platysma muscle is flat and smooth aging changes the muscle tone and it appears to separate into what is seen as platysmal bands if there is little to no loosening of the overlying skin then treatment can be done with a neurotoxin like Botox or Jeuveau to relax the muscles so the bands are less prominent particularly with movement if the platysmal bands are too loose then i can perform a surgical procedure called a platysmaplasty to improve the neck angle

A platysmaplasty can be performed as a standalone procedure or with a more extensive neck lifting procedure when there is significant neck laxity a surgical neck lift can be the best option for this particular issue a surgical neck lift can be performed as a separate procedure or in combination with the facelift i routinely discussed in consultation that the neck does not age in isolation but rather some of the skin under the chin is caused by sagging of the facial skin downward the patient will often recognize that when they lift their cheeks upward and the skin below their chin looks much better the purpose of a face-up surgery is to restore the anatomy of the cheeks jawline and neck which have descended due to age-related tissue laxity a typical facelift incision is placed strategically in front of and behind the ear

When a neck lift is performed at the same time the incision is extended further behind the ear in order to be able to redrape the neck skin and remove any excess skin that overlaps it is sometimes confusing for people to understand which type of facelift is best for them due to the wide use of proprietary names regardless of the branding of different facelifts there are some basic principles that apply when a surgeon is determining the optimal strategy for you basically the type of facelift you need depends on the degree of facial skin muscle and soft tissue laxity a mini lift for example or short scar facelift has a shorter incision and is typically performed when there is minimal skin laxity characteristically seen in people who are in their 50s or early 60s for people in their later 60s and older a more extensive facelift like a deep plane facelift and neck lift can be necessary in order to address more extensive cheek descent and excessive neck skin since a large proportion of facelift and neck lift surgery is performed under general anesthesia patients are often concerned about prolonged recovery very often people coming for a facelift surgery consultation are familiar with someone who they know who underwent surgery and it was their experience was characterized by significant bruising swelling and weeks of recovery

In my practice i perform face and neck lift surgery under local anesthesia with LITE IV sedation so our patients are comfortable in a twilight state of consciousness breathing on their own throughout the surgery

This is to contrast with general anesthesia where patients are temporarily paralyzed and need to breathe with the assistance of a ventilator patients under general anesthesia often have to stay overnight at a facility after surgery with skilled nursing assistants for monitoring and wound care such as needed when there are drains in our practice when i perform these procedures using local anesthesia and light iv sedation patients go home afterwards and with the basic facial dressing

Generally my patients return to work about a week to two weeks after surgery depending on the type of facelift we performed surgical neck lifts are usually indicated for advanced aging when neck skin muscle and soft tissue laxity is too extensive to address with more conservative procedures neck rejuvenation can be effectively performed with minimally invasive procedures ranging from the application of platelet-rich plasma long-pulsed laser neurotoxins such as Jeuveau and suture suspension these procedures can also be combined for more optimal minimally invasive neck rejuvenation the marketplace is saturated by medical retailers pedaling procedures and devices which mostly over promise and under deliver on any given day

I see patients who went from one place to another having different brand name non-surgical miracle neck tightening devices procedures only to be disappointed by their results and frequently distressed because they feel that their neck skin is actually even worse than before there’s never been a greater need for people considering neck rejuvenation to find an unbiased cosmetic doctor who can help them develop a neck rejuvenation strategy

I hope you found this information helpful thank you for your question

Can I have fat grafted under the eyes to treat hollowness?

People suffering from hollowness under the eyes often consider fat grafting after doing

research online.

They like that fat is natural and can last longer than cosmetic fillers.

Fat grafting can help with volume correction areas where the skin is thick.

I have had good results with fat grafting for hand rejuvenation.

Unfortunately, it can be problematic in the thin skin under the eyes, which is the thinnest in the body.

I’ve observed that many general plastic surgeons offer fat grafting under the eyes.

I will discuss the pros and cons of fat grafting under the eyes, in particular my experience caring for patients who had complications such as irregularities from variable healing, inflammation and scarring.

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 I said earlier, it is understandable why people want a natural material like fat to be used to treat under eye hollowness.

They figure it is the lack of fat under the eyes that causes hollowness, so it is logical to put fat back in that area.

They also may think that fat is a natural material from their own body, so their body can accept fat more easily since it’s not a foreign material.

However, when you learn about the nature of fat, you will find that it does not behave like you assume it will.

The term fat graft means that the fat is harvested from its original location such as the abdomen with liposuction.

As a graft, it relies on the local tissue where it is transplanted to receive adequate blood supply so it can survive.

Unlike a cosmetic filler, fat needs to have a blood supply in order to continue to be viable.

If fat does not get adequate blood supply, it breaks down and can cause inflammation and the creation of scar tissue.

In addition, I’ve seen situations where the fat or fatty tissue partially survived and was placed at different levels of the under eye area resulting in highly irregular contour.

Lumps and irregularities are the exact opposite of the goal of creating smooth volume in hollow areas under the eyes.

I also often see people who had fat grafting elsewhere and complain that none of it stayed.

I say to them that they are actually fortunate since there is no need to do additional surgical correction.

As a cosmetic eyelid surgery specialist, I am frequently contacted by patients to surgically remove fat grafts under the eyes.

Removing grafted fat under the eyes is highly specialized procedure, and may take more than one revision surgery.

There are times where I need to actually restore tissue quality under the eyes with regenerative medicine technology such as the application of prp or platelet rich plasma and stem cell based wound healing technology such as extracellular matrix before performing corrective surgery due the degree of compromise in the delicate integrity of the lower eyelid anatomic support.

Fat grafting involves surgical recovery from where the fat was grafted, such as the abdomen, as well as the graft site.

The abdominal recovery is usually not an issue.

Swelling from the placement of fat under the eyes can be significant for weeks to months afterwards.

I’ve seen patients who had persistent swelling from damaged lymphatics years after having fat graft surgery.

People also think that fat from their own body will not cause allergic reactions like filler, or be more accepted by the body than filler.

Hyaluronic acid, which is used in popular fillers like Restylane and Juvederm, does occur naturally in the body.

The chance of allergy is so low that we routinely place filler without having to do any skin testing.

Hyaluronic acid fillers are safely metabolized by the body with time, and can also be easily dissolved using the injectable enzyme hyaluronidase.

In my practice, for under eye hollowness that requires volume correction, I use hyaluronic acid fillers like Restylane or Juvederm.

Softer or less thick fillers are ideal for the under eye area.

I place injectable fillers under the eyes using blunt cannulas instead of needles to minimize the risk of bruising.

Blunt cannulas are less likely to pierce a blood vessel to cause bruising.

Unlike fat grafting, this is a non-surgical procedure and can be done in minutes.

Placement of injectable fillers in a way that is harmonious with the face is an art.

Knowledge and experience as an Oculofacial Plastic surgeon has been very useful for me when I place hyaluronic acid fillers.

When it comes to lower eyelid aesthetics, I also look at the front of the cheek in an area called the eyelid-cheek junction.

Sometimes, volume loss at the cheeks may leave filler placed under the eyes without proper cheek support.

In such cases, I also add volume to the cheeks to support the under eye filler, and also improve the global look of the whole face.

After placement of hyaluronic acid filler under the eyes, there is little downtime.

Most patients don’t experience any bruising, so they can return to their normal activities afterward.

Some swelling can be present from the use of local anesthetic.

Swelling from injectable fillers is usually minimal, and if present, can resolve within the first week.

If, for any reason a hyaluronic acid filler needs to be removed, it can be easily dissolved with an enzyme called hyaluronidase.

Although most patients look good immediately after filler placement, I see my injectable filler patients two weeks after the original procedure to see how the filler has settled, and if any enhancement is needed.

Injectable fillers under the eyes can last up to a year before gradually being metabolized by the body.

In my opinion, fat grafting under the eyes is too unpredictable with a higher risk for undesirable outcomes.

Its for this reason, in my practice, I recommend the placement of hyaluronic acid filler which has the advantages of convenience, safety and even reversibility.

I hope you found this information helpful…thank you for your question

Earlobes can stretched from the use of heavy earrings that elongate the earlobe.
There are also situation of stretching of earlobe piercing.
Fairly common, the piercing can be torn through, leaving the earlobe split.
Many people come in concerned about the appearance of their earlobes, particularly because of
the limitations associated with wearing earrings
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 often perform ear cosmetic surgeries for issues like bringing prominent ears closer
to head, correcting pixie ear deformities from facelift surgery, and reconstructive
ear surgeries such as repairing elongated and torn earlobes.
As with all cosmetic procedures, artistry is important.
I assess the amount of tissue present and determine the optimal way to restore the appearance
of a natural earlobe.
This means that there are times when there is so much stretching from age and the weight
of jewelry, an earlobe reduction is necessary.
Some situations are more straightforward such as an elongated piecing.
In this case, the skin is removed like removing the hole in a donut and the skin is the repaired.
After a few weeks of healing, the earlobe can be pierced.
My assistants and I will look with the patient for the ideal location of a piercing.
We place small gold stud earrings to allow the new hole to form which once fully healed
will allow the patient to put earrings of their choosing, of course I recommend that
the jewelry not be too heavy.
Often, the skin of the earlobe can be thinned from volume loss due to aging, causing them
to be floppy and stretched.
In such cases, the addition of using a cosmetic filler such as in the hyaluronic acid family
can augment the lost volume.
Cosmetic filler alone can be used if the ear was not significantly elongated.
In cases of elongation, then surgical earlobe reduction is needed.
Earlobe reduction is achieved by excising part of the stretched and elongated earlobe,
and surgically closing it with sutures to restore a more natural and attractive appearance
to the earlobe.
After healing, cosmetic filler can also be injected into the earlobe to add volume for
fullness and firmness.
The principles of earlobe reduction can also be applied to cases where the earlobe by accident
or prolonged use of heavier jewelry caused the earlobe to tear through.
The skin from the edges of the tear are excised, and then the two sides of the earlobe sutured
together.
Sutures from earlobe repair or reduction are removed after one week.
Patients can normally return to work the day of or the day after the procedure, which is
typically performed with local anesthesia.
Earlobe aesthetics are very important to many patients who I see in my practice.
Problems ranging from elongated piercings, to stretched and split earlobes can be addressed
effectively with artistically performed procedures routinely performed under local anesthesia.
I hope you found this information helpful…thank you for your question.

After dimpleplasty, how long will the indentation be visible when not smiling?

The desire to have dimples has been growing in popularity in my practice for years.

Regardless of ethnic background and cultural differences, there seems to be a universal appreciation of the attractiveness of cheek dimples.

I’ll discuss how I help a wide range of people who come from around the world have a procedure called dimpleplasty and what the recovery process is like.

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 became well known for dimpleplasty, since relatively few cosmetic and plastic surgeons offer this procedure or perform it often enough to make it a routinely performed procedure in their practice.

We have even featured in the media for this procedure which to some degree driven by some popular celebrities whose dimples inspire people to want the same.

In addition, many of my patients relate stories about their families where certain family members had dimples and received praise for them in a way which made the patient focus on having dimples themselves.

Natural dimples actually occur due to a defect in a muscle in the cheek called the buccinator

muscle.

When a person with this defect smiles, there is dimple.

Natural dimples can be shallow to deep as well as symmetric or asymmetric.

In terms of the dimpleplasty procedure, I take measurements from the corner of the mouth to the cheek to determine what I call “the sweet spot “for dimple placement.

Anatomically, I try to create a dimple where would have occurred naturally.

In fact, there is actually a limited zone where a dimple can be most effectively placed.

Even though I try to place the dimples as symmetrically as possible, I show my patients how the human face is naturally asymmetric.

I usually have patients place something on the cheek to press inward to see where the dimples will be placed, and how they will look when smiling.

Once we’ve agreed on the planned placement, we do the procedure.

The procedure is typically done from the inside of the cheek although an outside approach my ab necessary in some situations.

I create a small opening inside cheek and I connect the buccinator muscle to the cheek

skin with a suture. This results in an indentation which confirms a successful connection has

been made.

In terms of the healing process afterwards, there are two important aspects of dimpleplasty

healing.

The first is that this procedure is done from the inside of the mouth, which naturally has

a lot of bacteria.

I discuss with patients some precautions about food and oral hygiene..

The second aspect to be aware of is the presence of a visible dimple at rest.

Patients who have this procedure understand that a temporary indentation in the skin will be visible even when not smiling, during the healing the process of this surgery.

Interestingly, most patients don’t have any issue with this.

As healing progresses, the presence of the indentation diminishes so that the dimple appear more with smiling than at rest.

The presence of indentations at rest can be present for several months after surgery.

Variables which affect the depth and more obvious appearance include skin thickness, skin type, age, facial fat volume and surrounding bone structure.

Dimpleplasty is an outpatient procedure done with local anesthesia, so recovery is quick.

Patients normally return to work a few days after the procedure.

The appearance of dimples become stable as the temporary indentation is no longer visible when the face is at rest.

Having a strong connection between the skin and muscle is key for long lasting dimples.

Maintaining long lasting dimples has some relationship to weight gain since an increase

in fat volume in the cheeks can cause dimples to become less prominent and even no longer visible.

Sometimes dimpleplasty needs to be revised if the depth of the dimple becomes too shallow to the point where the dimple doesn’t appear with smiling.

Dimpleplasty can dramatically accentuate your smile, and enhance your facial features, without otherwise altering your facial characteristics.

I can say that many dimple patients are highly motivated and are extremely happy with their results.

I hope you found this information helpful…thank you for your question.

Ernie Anastos : Say “cheese” because people are willing to pay thousands dollars for that perfect smile and for some that means dimples.

Dr. Prasad: People like dimples.

It’s a unique group and there is a tremendous interest in it.

We’re surprised with the amount of people who want to have dimples.

Dr. Amiya Prasad’s phone has been ringing off the hook.

People are seeking his expertise in dimple plasty that is the creation of dimple.

Yes, dimples.

Dr. Prasad: They think of celebrities like Jennifer Garner or Mario Lopez and they like

those dimples.

And so people come from all over the country and sometimes outside of the country to have

dimples done.

Teresa Priolo: Dimpleplasty is nothing new.

It’s actually been at least around the last three decades.

The procedure is popular with both men and women but Dr. Prasad says they tend to be

in the younger age in their mid-twenties and thirties.

Dr. Prasad: a lot of times, people who have rounder faces will get this done so people

would think that they lost weight because they have a little more angularity with the

face.

Teresa Priolo: That’s exactly the motivation behind Lisa Williams’s surgery.

She spent the last year considering it and now she’s ready to take the plunge.

Lisa: I just want something that will perk me up a little bit.

Make me a little bit cuter and have a memorable smile.

Teresa Priolo: To begin, Dr. Prasad finds where her natural would sit.

He measures from the corner of the eye down.

Dr. Prasad: and then we kind-of measure out.

It’s somewhere around 3 centimeters, a point where we anticipate close to where it will

be.

There is kind-of a sweet spot where the skin will naturally give us permission to fold

a little bit and look natural.

Teresa Priolo Once he marks both sides of the face, Lisa gets an idea of what her new

smile will look like.

And then it’s off to the OR.

Dr. Prasad: We’re working from the inside of the mouth and we’re manipulating a particular

muscle and attaching a stitch to the skin from the inside.

So no one sees a scar.

Teresa Priolo: No scar, hardly and swelling or soreness and in about a half an hour’s

time, you have the dimples you didn’t have before.

Can you tell the difference between that come from mom and dad and dimples that come from

you?

Dr. Prasad: well, at the point where the actual surgical dimples settle out and become natural,

then it’s really hard to tell.

Teresa Priolo: And isn’t that the point?

Teresa Priolo, Fox 5 News.

Are cheek and chin implants really permanent?

A sad reality of facial aging is the progressive loss of youthful volume as you age the face loses definition it becomes more flat and even sunken in particular the cheek area and the chin areas are frequently recognized as having lost significant volume particularly when you take a look at your profile it’s very popular for many people to get fillers to address their volume loss interestingly there are many people who don’t feel that the fillers are working as well as they want or they get tired of going in frequently to have these filler injections they experience swelling and bruising and eventually develop filler fatigue and become interested in something more permanent in their quest for a permanent solution they become aware of facial implants they perceive that facial implants such as cheek and chin implants are the permanent solution they’re looking for although these implants can appear to look very good for several years there are important age related changes that may not make this option the best choice of having facial implants for the long term as they may appear to be

I’ll discuss how i adapted my approach to facial volume loss from surgical implant placement to longer-lasting non-surgical solutions 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 new york city and long island for over 25 years as a facial cosmetic surgeon

I perform all types of facelift surgery from short incision mini lifts to extensive deep plane facelifts I do perform cheek and chin implant placement surgery both with facelifts and as standalone procedures I also routinely perform non-surgical volume enhancement using injectable fillers in the lips the eye area the cheeks jawline and chin it’s natural to assume that cheek and chin implants are permanent because they aren’t metabolized like hyaluronic acid fillers while cheek and chin implants which are usually made of a soft silicone material are not going to be metabolized

Your underlying facial structure is not permanent the same aging process that causes the loss of facial volume which is primarily diminishing bone volume as well as loss of fat muscle soft tissue and skin thickness continues after facial implants are placed this progressive loss of facial volume occurs at the foundation of where the implants are anchored like the cheek bone and the chin while it’s common practice for the cheek implants to be stabilized or anchored in place using titanium screws or bolsters for stabilization in order to maintain a desired position there will be continual changes of the natural anatomy including the bone muscle fat and surrounding tissues this progressive change can result in a disproportionate appearance of the facial implants relative to the rest of the face as there is progressive fat loss below the skin and the skin becomes thinner it’s also possible to see the actual outline of the implant these issues also apply to chin implants

Although usually not as significant recognizing the presence of natural asymmetry and subtleties of contour the implants often have to be modified during surgery this typically involves shaving the silicone and observing the effects on the facial contour this becomes particularly challenging because of normal intraoperative swelling due to the presence of anesthetic and natural reactive tissue swelling further there are other soft tissue aspects which cannot be adjusted for by carving the implants so postoperatively to optimize the appearance it can still be necessary to employ the use of soft tissue fillers to help optimize the longevity and resilience of hyaluronic acid fillers the makers of hyaluronic acid fillers introduced new fillers such as Juvederm Ultra Plus and Juvederm Voluma although these fillers were a major step in the right direction a common source of frustration is that in spite of the filler’s improved viscosity and longevity people who want to have better cheek definition and chin definition end up looking soft and doughy the doctors who place these fillers are also frustrated because when they place the fillers under the skin and intentionally mold the fillers to look like cheekbones and other facial structures unfortunately the look they achieve in the office does not last since conventional placement of hyaluronic acid fillers result in the fillers migrating there was a clear need to place the fillers in a way where migration would be less of a problem in some ways this is comparable to cooking where you have the right ingredients but what you need is the right technique fortunately the right technique in my opinion has been developed by adapting strategies and anatomic knowledge from facial implant surgery when we look at relative proportionality of volume loss associated with facial aging it’s clear that the most significant impact is at the bone level

This is why facial implants are placed on top of the bone structure this of course begs the question why are soft tissue fillers to improve facial structure placed just below the skin level it should be no surprise that these fillers end up being displaced and creating the stereotypical “pillow face” appearance this means that there needs to be a consistent and predictable method to place long-lasting filler at the bone level to take advantage of the strong foundation and the intrinsic shape inherent to the bone structure although many of my colleagues and non-physician injectors believe that they are placing filler at the bone level when they do a demonstration and show how the needle they’re using is hitting the bone they’re not really delivering the filler into the space that optimizes an enhanced structure

In addition these well-meaning injectors doing these demonstrations repeatedly pierce the skin with their needle thereby inducing more bruising and swelling than would be necessary I employ a technique called Structural Volumizing since I’m creating more definition by placing volume on the bone structure

I believe by placing this thicker and longer lasting filler using blunt cannulas instead of needles I’m able to deliver the material i want into the spaces above the bone in a smooth almost frictionless way reducing the risk of bruising swelling and other potential complications I’m essentially performing a non-surgical treatment by applying my surgical knowledge to place the filler at a deeper level my patients are typically very happy about how good they look immediately and rarely have any concerns about bruising and swelling the next day by placing the filler mostly at the bone level

I can be more conservative with the volume if i need to place any filler below the skin level to address any subtle contour issues by using this approach of placement in limited quantities below the skin the filler is less likely to be displaced i usually see my patients again after two weeks to see how they look after everything is settled something worth mentioning is that if there is any issue with the facial implant then surgery is necessary to remove or exchange the implant with structural volumizing even at the bone level hyaluronic acid filler can be quickly dissolved by using the enzyme hyaluronidase when considering cheek and chin augmentation for a more youthful appearance remember our facial dimensions change with age but the facial implants don’t by using thicker hyaluronic acid fillers placed by applying the principles of facial implant surgery we achieve the same results in many situations as a surgical procedure with greater flexibility and precision with lower risk while fillers do not last as long as surgical implants they do last longer than they did previously and are certainly far more convenient for my patients I’ve also observed that many people who would have otherwise objected to undergoing any kind of facial implant surgery are much more interested in having Structural Volumizing because of the convenience safety predictability and reversibility

I hope you found this information helpful thank you for your question

What should I look for in a facelift surgeon?

It can be confusing and overwhelming for anyone considering a facelift. As to what procedure is right for them. Assuming you already have an understanding that you need facelift surgery. And you find yourself being confused by the different branded procedures. And the claims such as I only perform deep plane facelift. I’ll share with you what I feel is important in looking for a facelift surgeon.

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 facelifts and neck lifts throughout my career. And even during my fellowship experience, I was already thinking of how to make facelift surgery and recovery better without sacrificing results.

I perform all types of facelifts from short scar facelift, deep plane facelift, face and neck lifts. And even non-surgical facial filler treatment called the Y lift. Which for people who have had bone volume loss. And are not candidates for facelift surgery as an ideal solution.

In my opinion, when searching for a facelift surgeon. The first thing you should look for is a doctor who spends time listening to what you want. And closely examines your face and neck. I feel that a doctor who takes their time with you is more likely to plan. And customize the procedure according to your facial aging issues.

I feel that facelift doctors who rush through consultations are often associated with so-called “miracle” facelifts. Or just too busy to do their best work for every patient. I believe its critical for anyone considering a facelift to get a clearer sense of a doctors aesthetic style.

Some doctors and their patients consider a stereotypical plastic look to be ideal. My personal aesthetic style for facelifts and other cosmetic procedures I perform is a more natural looking aesthetic. I believe in both preserving the natural facial character of my patients.

Such that any enhancement results in a younger looking and more refreshed version of themselves. It’s important that your personal aesthetic is a good fit with the aesthetic style of your prospective doctor. A way to do this is to look at examples of their before and after photos. As well as your impression during consultation. As what they describe is what they would do for you.

Experience with expertise in facelift surgery is very important. In an effort to promote experience and expertise it’s common for surgeons to drop names like deep plane facelift or MACS lifts. To create the impression that only they do these procedures. The fact is that all experienced and reputable facelift surgeons perform many different facelift techniques. I explained during consultation that what is planned during surgery is continuously adjusted. Based on anatomy revealed during surgery. One factor that separates facelift surgeons from one another is the expected recovery time. And type of anesthesia used. Many facelift surgeons only perform facelifts using general anesthesia.

During my training, facelift surgery was always performed under general anesthesia. At the time I looked at the processes involved. And began working on ways to make facelift surgery a safer and more convenient procedure.

After my training was completed I started doing face lift. Eventually, all my cosmetic procedures with local anesthesia with LITE™ IV or intravenous sedation patients are in a state of twilight consciousness. But not paralyzed or on a respirator. While experienced faceless surgeons can work with general anesthesia with good results. I feel that the tube placed in the throat through the mouth during general anesthesia can distort the face and affect the surgical outcome.

It’s common after general anesthesia for patients to stay overnight at a facility with nursing care for monitoring. It’s also common after general anesthesia for patients to experience nausea and vomiting. This all leads to prolonged and challenging recovery.

In contrast, in our office using local anesthesia with light sedation. Facelift patients go home in about one to two hours after surgery. And can get back to work in about a week the level of swelling. After surgery is also considerably less. When comparison to patients who have had face of surgery under general anesthesia.

In my practice patients considering facelift surgery get ample opportunity to speak freely with my medical staff. As well as my administrative staff about the experience of other patients patients considering facelift or any other procedure. Get a sense of how familiar at an enthusiastic the office staff is with the procedure they’re considering if you get the impression that the staff is honest knowledgeable and enthusiastic. It’s a good sign a facelift alone does not solve all aging issues in the area of the cheeks and jawline.

When I do a consultation for facelift I discuss other facial aging issues. Such as volume loss at the bone level which cannot be addressed by facelift surgery. But rather by long-lasting fillers or facial implants. Many people wrongly assumed that a facelift with the need to have fillers in the future.

Often plastic surgeons will perform a facelift and let the patient believe they won’t need fillers after surgery. Sometimes they try to address volume loss with fat grafting. I can tell you that many people have come to me after having facelift surgery with fat grafting and realized that most, if not all, the factors appeared. Also fat grafting is not effective in restoring volume at the bone level.

In addition, the same plastic surgeon who performed a facelift will have non-physician staff members do the injectable treatments. I approach things differently I provide my patients with comprehensive strategy with the clear understanding of the limits of facelift surgery. And the approach to bone loss using Structural Volumizing with long lasting hyaluronic acid fillers placed at the bone level.

I can attest to the advantage I have as a surgeon with extensive experience with facial implants such as cheek and chin implants. When it comes to placing long lasting hyaluronic acid fillers at the bone level it’s important to be comfortable with your facelift surgeon. You should have confidence in the surgeons expertise experience and aesthetic style. This level of trust in my experience results from spending enough time in consultation. And the education process before surgery.

I hope you found this information helpful thank you for your question.