Archives: Transcript

How do I treat my eyes and eyelids affected by thyroid eye disease?

Thyroid eye disease also known as Graves’ disease or thyroid related immune orbitopathy are commonly referred to with the acronyms TED or TRIO can significantly affect the appearance of the eyes and eyelids I often see that people affected by this condition who are eager and highly motivated to improve their appearance with surgery as soon as possible it’s important to understand how this disease progresses and how the disease is managed in order to determine the optimal time to perform surgical procedures when indicated

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 helped many people throughout my career with thyroid eye disease improve their appearance through different specialized procedures specific to the unique issues associated with thyroid related immune orbitopathy

Thyroid eye disease occurs when antibodies in your blood affect the thyroid as well as the tissues around the eyes for example inflammation from thyroid eye disease can affect the muscles and fat behind the eyes causing the eyes to bulge and protrude forward the upper and lower eyelids can also retract with or without the eyes bulging forward creating a staring type of appearance in terms of surgical correction it’s important to determine whether the thyroid eye disease is in an active inflammatory stage or a stable fibrotic stage the inflammatory stage is typically a time when the eye appearance is changing and the thyroid hormone levels are being managed by an endocrinologist medical management of the inflammation as well as the thyroid hormone can include interventions such as radioactive iodine steroid radiation therapy as well as medications to supplement or reduce thyroid hormone levels

This inflammatory stage can last two to five years surgery is usually not performed at this time unless there is a situation when vision is being compromised after the inflammatory stage is the fibrotic stage this period is characterized by the appearance of the eyes being more stable I confirm this by taking measurements of the relative prominence of the eyes using an instrument called an accelerometer as well as when appropriate slit-lamp examinations and of course taking clinical photos I routinely perform procedures to address the retraction of the eyelids as well as the changes in the skin and fat volume around the eyes there are times when thyroid eye disease can cause ptosis as well as laxity of the support structures such as the lateral canthal tendon for example I treat lower eyelid retraction with specialized procedures to raise the vertical height of the lower eyelid using a graft such as decellularized dermis

In addition I’ll perform a repositioning or reinforcement of the lateral canthal tendon using different methods of canthopexy or canthoplasty depending on the individual situation upper eyelid retraction can be addressed using procedures such as a removal of a muscle called Mueller’s muscle referred to as Muellerectomy I also perform procedures on the levator muscle the muscle which lifts or opens the eyes to allow the eyelid to move downward and use a graft material such as temporarily muscle fascia excess skin and fat can be addressed by more traditional cosmetic procedures such as upper and lower eyelid blepharoplasty however the relative prominence of the eyes and the inflammation that occurred does require in my opinion the unique skills and experience of an oculoplastic surgeon I regularly performed these eyelid restoration procedures under local anesthesia with LITE IV sedation so general anesthesia is avoided and my patients are comfortable and are able to return to work often in one week

I perform these procedures in my in office surgical facilities I do caution my patients with thyroid eye disease that there are some situations where the results may be challenging to achieve and secondary procedures may be necessary I’ve seen how tyroid eye disease can have a significant impact on a person’s facial appearance after the inflammatory stage has transpired and the eyes are stable in the fibrotic stage I work with my patient on a treatment strategy that best addresses their appearance with minimal risk I helped many of my patients restore their confidence and feel great about how they look after I performed their surgery

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

What are the risks of lower eyelid surgery?

Cosmetic lower eyelid surgery lower eyelid blepharoplasty is amongst the most popular cosmetic surgical procedures performed throughout the world the appearance of puffy eye bags that are present all the time is due to bulging fat and is commonly genetic in origin as well as being associated with facial aging the genetic aspect of this condition is why many younger people have under-eye bags the most effective and longest lasting procedure for puffy eye bags is lower eyelid surgery to sculpt the fat responsible for the under eye bags

The popularity of lower eyelid surgery can make it appear to be a generic procedure in actuality it’s anything but generic many surgeons performing this category of surgery use a one method fits all approach resulting in many people needing corrective procedures by specialists like myself the lower eyelid is a complex structure and the art is in creating the optimal strategy to get the most satisfactory result with minimal risk for complications I’ll discuss how I assess my patients and how I customized the procedure to minimize the risks related to lower eyelid 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 as an oculoplastic surgeon who specializes in cosmetic eyelid surgery I routinely perform lower eyelid blepharoplasty as well as eyelid revision surgery for complications after surgery originally performed by other doctors I’ve observed throughout my career that a lot of complications after lower eyelid surgery occur because the surgeons performing this procedure are not fully aware of the ways to avoid compromising the support structures intrinsic to the lower eyelid anatomy one of the more common risks of lower eyelid blepharoplasty is lower eyelid retraction the degree of eyelid retraction can be such that the eyes look rounded after surgery and the patient loses the characteristic shape of their eyes I’ve seen patients who had this problem after surgery and their original surgeon denied that the patient had a rounded appearance of their lower eyelids it seems that there’s been a normalization of rounded lower eyelids similar to the normalization of high arched eyebrows and overfilled lips

This is why during consultations patients will often express their disdain for the look of some famous people who they feel look like they’re a deer in headlights so what is the cause for this eyelid retraction problem well the most commonly performed surgical technique to address fat under the eyes which causes puffy eye bags is called transcutaneous blepharoplasty this technique involves making an incision in the lower eyelid right below the eyelashes to access the fat pockets responsible for puffiness the transcutaneous blepharoplasty technique is often performed by general plastic surgeons this approach has the potential to compromise the strength of the eyelid structure by separating the layers which are stronger when intact in addition there is potential compromising of the function of the orbicularis oculi muscle which works like a belt supporting the lower eyelid this can lead to the lower eyelids sagging or pulling downward making the eyes look rounded instead of retaining their original shape and it’s referred to as lower eyelid retraction

The lower eyelids may also rotate inward causing irritation from the eyelashes known as entropion or avert outward causing irritation from exposure known as ectropion further worsening this compromise of the integrity of the lower eyelids is caused by the common practice of eyelid skin removal as a strategy to improve the appearance of fine lines and wrinkles

A common misconception held by many surgeons and the general public is that the fine lines and wrinkles are the result of excess lower eyelid skin so many surgeons excise skin when performing transcutaneous bluffing this removal of skin often leads to the lower eyelids retracting even further and can lead to a more rounded look and worse a skin shortage where the eye is not adequately protected this can cause the tears to not be evenly distributed over the eyes to maintain proper eye health in some situations there can even be a limitation in high closure when sleeping I approach lower eyelid retraction ectropion and aunt ro beam with one guiding principle restoration of anatomy eyelids that look good function well this means for eyelid retraction in order to restore anatomy I have to use tissue grafts such as dermis cellular matrix graft and even skin grafts to reconstruct and provide vertical support

I also have to repair the anatomic structural connection to the bone called the lateral canthal tendon each patient situation is unique and requires proper evaluation I use advanced wound healing technology such as PRP or platelet-rich plasma and a cellular matrix to improve my patient tissue healing and consequently their outcomes it’s often the case that lower eyelid fat prolapse is associated with the deficiency in the projection of the cheek bone and bone structure under the eyes the paradox is that there is excess fat pushing forward while deficient bone is not projecting forward enough I usually recommend placement of hyaluronic acid filler at the bone level to address bone volume deficiency some doctors advise fat repositioning with lower eyelid surgery where a small extension of fat still connected to the eye is stretched and bent over the bone to try to address this deficiency this pedicle of fat is usually too small to address hollowing and the blood supply is kinked over the bony orbital rim resulting in prolonged swelling irregularities or the fat just dying from the blood vessels being bent and compressed to provide adequate volume as well as a more predictable result

I use hyaluronic acid fillers such as Restylane and Juvederm to address hollowness in the lower eye area as well as the cheek bones I bring to my patients attention the relationship between the bone structure around the eyes and the eyes themselves so they can look their best it is of course much better to completely avoid lower eyelid retraction of other complications than it is to need extensive and expensive revision surgery so many people opt for cheaper lower eyelid surgery to save money without understanding why the surgery is being done so cheaply quality and cheap simply don’t go together so opting for cheaper lower eyelid surgery can be much more expensive to fix not to mention the cost of time off work and the expenses of travel

So how do I minimize the risk of lower eyelid retraction I start with the approach of preserving the lower eyelid support structures such as the lower eyelid skin and the orbicularis oculi muscle I preserve lower eyelid Anatomy by using a specialized technique called transconjunctival blepharoplasty transconjunctival blepharoplasty involves no external incision because the fat pockets responsible for under eye bags are sculpted from behind the eyelid the lower eyelid skin and the orbicularis oculi muscle are completely preserved and the results look natural since there is no scar from an external incision and there is no compromise in the support structure I also avoid skin removal because under eye wrinkles and fine lines are an issue of skin quality not excess skin quantity for under eye wrinkles I improve the quality of the skin by stimulating collagen production and resurfacing the skin collagen can be stimulated using a laser or radiofrequency device to induce collagen production collagen is the protein that gives skin its strength

In addition the application of heat also makes the skin contract and tighten to further stimulate collagen production and blood supply in the lower eyelid skin without heat I use platelet-rich plasma platelet-rich plasma also called PRP is a concentration of wound healing and growth factors present in the blood which are activated when you have a cut if there is redundant lower eyelid skin or a fold I’ll perform a skin pinch excision I still focus on maintaining the natural shape and the character of the lower eyelids I perform lower eyelid surgery under local anesthesia with Lite IV sedation so patients don’t have to deal with the stress of general anesthesia as well as the side effects of general anesthesia patients are comfortable throughout the surgery and what is generally referred to as a twilight state of consciousness they walk out of our office alert and happy soon after surgery

Most of our patients have little to no bruising and return to work in about a week like any surgery there are always risks risks can be minimized through the experience expertise and techniques used by the surgeon coming from an ophthalmology background and having an understanding of how to maintain the shape and retain the healthy function of the eyelids has been invaluable for my ability to help my patients undergoing lower eyelid surgery

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

What is the difference between upper blepharoplasty and ptosis correction?

Hooding or drooping of the upper eyelids that gives you a tired look is often seen with normal facial aging if you are considering cosmetic enhancement of your upper eyelids to help you look more refreshed then you should know the difference between excess skin over the eyes and eye muscle related drooping eyelids why because these are two distinct issues and are managed very differently I often see patients who had cosmetic upper eyelid surgery performed elsewhere who still feel that they looked tired because of their drooping eyelids this often means that the operating surgeon didn’t address a condition called ptosis a medical term to describe a drooping upper eyelid I’ll discuss the difference between hooded upper eyelids and ptosis as well as how i address these conditions in my practice.

I’m Dr Amiya Prasad, I’m a diplomate of the American Board of Cosmetic Surgery and a Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in New York City and Long Island for over 25 years, I perform a range of cosmetic eyelid surgeries to treat issues like hooded upper eyelids puffy under eye bags and Asian double eyelid surgery as an oculoplastic surgeon. I trained first in ophthalmology so I perform specific types of eyelid surgery that’s usually not done by general plastic surgeons such as treating eyelid ptosis upper and lower eyelid retraction and treating eyelids affected by conditions like thyroid eye disease.

So how do we differentiate eyelid hooding from drooping upper eyelids or ptosis upper eyelid hooding is typically due to the eyelid skin stretching or sagging due to collagen loss and changes in skin elasticity as your upper eyelid skin changes it folds upon itself so there appears to be excess hooded skin over the eyes this condition is referred to as dermatochalasis when you have drooping eyelids or eyelid ptosis the position of the eyelid margin.

Where the edge of your eyelashes emerge is lower than it normally would be people with eyelid ptosis are often aware that one eyelid is actually lower than the other some people aren’t even aware that their eyelids have descended significantly and are delighted to experience how much better they feel when their eyes are actually more open other people have told me that they struggle to keep their eyes open and they feel fatigue from straining to keep their eyes open eyelid ptosis associated with aging is typically due to a stretching or detachment of the muscle that lifts the eyelid called the levator muscle levator is the word like the word elevator without the letter e interestingly ptosis can be present with dermatochalasis making the diagnosis of ptosis at times kind of challenging.

As I mentioned earlier the treatment strategy for hooded upper eyelids or dermatochalasis is different from eyelid ptosis so an accurate diagnosis is very important surgery for upper eyelid dermatochalasis is more than just skin deep the eyes are three-dimensional so addressing the deeper soft tissue is very important to achieve a natural and aesthetic result many patients express to me their concerns about being able to close their eyes after surgery they ask these types of questions because they’re aware of individuals who had eye-related problems due to the inability to properly close their eyes after aggressive upper eyelid skin removal.

I help people from around the world who have had this type of problem with advanced reconstructive procedures such as skin grafting to the upper eyelids to replace lost skin as an oculoplastic surgeon I’m familiar with dry eyes and other ophthalmologic issues which need to be factored in when planning cosmetic eyelid surgery.

I always say that eyes that look good function well my surgical aesthetic focuses on natural looking results which are more youthful and vibrant not plastic although redundant eyelid skin can be present at the same time as eyelid ptosis many people learn the hard way that removing eyelid skin alone will not treat eyelid ptosis.

As I stated earlier I see a lot of people who had upper eyelid surgery and then come to me to address their eyelid ptosis which wasn’t taken care of initially eyelid ptosis requires specialized surgery to shorten or reattach the levator muscle or another muscle called Mueller’s muscle I routinely perform cosmetic upper eyelid surgery or blepharoplasty with ptosis surgery I perform a lot of my ptosis procedures from the underside of the upper eyelid there are times when I only perform the ptosis surgery without making any incisions on the outside.

I perform upper eyelid blepharoplasty as well as ptosis correction surgery using local anesthesia with LITE IV sedation my patients avoid the side effects often seen with general anesthesia such as nausea and vomiting in addition to prolonged recovery from surgery so in closing I want to encourage anyone considering upper eyelid cosmetic surgery to understand the difference between upper eyelid hooding and upper eyelid ptosis if you suspect that you have ptosis as well as hooded upper eyelids a proper evaluation will help you have the procedures that are best suited for your situation.

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

Ptosis is a term which means “droop”.

When the eyelid droops, we call it “eyelid ptosis” Ptosis or eyelid droop is often referred to as a “lazy eye”. If you or someone you know has one or both eyes looking partially closed, you may be looking at ptosis.

In most situations, appearance and vision can be improved with ptosis surgery. I’ll help you understand what is responsible for the most common types of ptosis as well as how I work with my patients to formulate a strategy that will have the most likelihood for success.

I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I routinely treat a wide range of ptosis patients in my practice.

Many of my patients are patients who’ve undergone previous ptosis surgery done elsewhere. When I meet a patient with ptosis, I start by reviewing the history to see if you were born with ptosis or if you developed ptosis later. When someone is born with ptosis, it’s referred to as “Congenital ptosis”.

If you develop ptosis later, its referred to as “Acquired ptosis”. In either situation, I first establish that there is no neurologic cause for ptosis before discussing surgical options.

Ptosis is essentially the result of a condition affecting the “levator muscle”. The “levator muscle” is the muscle that lifts the eyelid, like the word “elevator”

The type of surgery I recommend depends on the cause of the ptosis as well as the strength of the levator muscle. Surgical correction typically involves either some type of muscle advancement or shortening. If the muscle is too weak, then surgery is performed to connect the muscle that lifts the eyebrows to the eyelid.

When patients considering ptosis surgery come to our office, they express a desire to have their eyes look open and as symmetric as possible. Very often, patients come in requesting cosmetic upper eyelid surgery for sagging skin and don’t realize that they also have ptosis.

During my evaluation, I explain how excess skin over the eyelids which is referred to as “dermatochalasis” is different from drooping of the eyelid caused by the levator muscle which is of course “ptosis”.

There are often times when people have had cosmetic eyelid surgery or upper eyelid blepharoplasty elsewhere and they come in concerned that they still look tired. The reason for this is that they had upper eyelid skin removed but nothing was done to address the underlying muscle responsible for they eyelid droop.

Most ptosis surgery is for acquired ptosis due to a progressive stretching or thinning of the levator muscle. There are some patients who come in saying they’ve always had low upper eyelids which were referred to as “bedroom eyes” and that as time went on, the eyelids became lower and made them look tired. The objective in surgery is position the eyelid lifting muscles which include the levator muscle as well as another muscle called “Mueller’s muscle” in an advantageous manner to improve the position of the eyelids. I explain to my patients that these muscles are very sensitive and achieving the ideal result can be challenging.

The surgery is performed under local anesthesia with light intravenous sedation. In most cases, I have the patient open their eyes so I can monitor the height and shape of the eyelid. In fact, I routinely will sit the patient up during surgery and evaluate the appearance of the eyes in a way which more accurately reflects being vertical in real life.

This particular aspect of the surgery allows me to anticipate more accurately the outcome we’re aiming for. I do qualify the predictability of the procedure with my patients by explaining that 95% of the time, the eyes look right and there’s a satisfactory outcome.

Approximately 5% of the time, enhancements are necessary and are performed when swelling is significantly diminished which is usually after 3 months. Eyelid swelling is a normal part of the healing process.

The extent of the swelling is dependent on the extent of the surgery and the individual patient’s physiology. In the first 2 days after the surgery, cold compresses help decrease the initial swelling after surgery.

After the first 2 days, the clearing of swelling depends on the amount of swelling and circulation. I encourage my patients to be up and about walking, talking and smiling and if they’re planning to be more sedentary, warm compresses can help. Most people go back to work after 1 week.

I see our patients routinely more frequently in the first 2 months after surgery and then in approximately 3 month intervals for a year after surgery. Generally, I expect appearance to by close to the final appearance around 6 months. If a patient has a history of allergies, sinus problems, smoking or other circulation issues, swelling can persist longer than is typical.

Ptosis surgery can have a significant impact in your appearance and confidence. Functionally, eyelid ptosis can also affect your vision, and visual development in children who have it between birth and the age of 6.

If you’re questioning whether or not you have ptosis and if you should have surgery, meet with Fellowship trained Oculofacial Plastic Surgeon and learn about your situation and options.

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

What causes eye bags?

Puffiness under the eyes is one of the most common concerns affecting men and women of all ages and
ethnic backgrounds the retail shelves are full of creams claiming to get rid of under eye bags many
of my patients come in with bags of these creams and other DIY remedies which all fail to deliver
any of the benefits they claimed the social impact of having eye bags can be very significant younger
people who are healthy and energetic are frequently perceived by others as being tired lacking in
sleep and even under the influence of drugs I’ll discuss the different causes of puffy eye bags as
well as treatments including non-surgical and surgical options to help people who i see with eye bags

I’m Dr Amiya Prasad I’m a board-certified cosmetic surgeon and a fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been practicing in New York City and long island for over 25 years
when people come to see me they often report that they tried everything they could before taking
the big step of coming in to see me they often will say how they were hoping to avoid needing surgery
i say to them although surgery may be appropriate I’m more than happy to help people who are candidates
using non-surgical procedures when appropriate i reassure them that being a surgeon provides a unique
insight that enhances my skills in performing non-surgical procedures puffiness under the eyes can be
seen temporarily due to the lack of sleep from allergies and even salt intake these types of puffiness
are caused by fluid and is subject to lifestyle and environmental factors under eye bags which are
always present are due to an anatomic issue called lower eyelid fat prolapse anatomically speaking fat
pads exist in compartments around the eyes and can shift forward like a hernia the term for this
phenomenon is lower eyelid fat prolapse or herniated fat lower eyelid fat prolapse can be hereditary
such as that many of my patients are younger people in their twenties and they’ve had their puffy eyes
appearance since they were teenagers facial aging changes which are characterized by volume loss
affecting the bones and soft tissues can also be associated with under eye fat packs certain lifestyle
factors like smoking can also contribute to weakening of the delicate tissue around the eyes resulting
in puffy eye bags thyroid eye disease can also cause you to have prominent under eye bags having puffy
bags under the eyes is commonly perceived by others as you looking tired or lacking sleep one of the
most common phrases i hear from my patients who have under eye bags is I’m tired of looking tired it’s
important to recognize that under eye puffiness is often associated with a deficiency in volume below
the eye this means that you can have too much volume pushing forward from lower eyelid fat prolapse
resulting in the appearance of under eye bags and at the same time have hollowing due to the lack of
volume in the bone structure below the under eye bags when i perform an examination of this area for
rejuvenation i look at specific anatomic details one i look at how much the bags under the eyes are
pushing forward two i look at the area of the tear trough and determine if the height of the under eye
bags are more or less than the height of a bone located just in front of the fat pocket called the
anterior lacrimal crest and third i look at the projection of the cheekbone and the area below the under
eye backs strategy for this assessment is to determine if your appearance can be improved non-surgically
with the placement of hyaluronic acid filler or by performing surgical sculpting of the prolapsed fat
pockets or even a combination approach using both surgery and cheek filler let’s look at a situation
where the fat prolapse is minimal and the projection of the anterior lacrimal crest or the bone structure
located towards the inner corner of the eye is at least the same height or higher than the height of the
fat i can precisely place hyaluronic acid filler in a space between the fat and the bone to create a
smoother transition and effectively camouflage the prominence of the fat pocket i perform this procedure
in my exam room and my patient leaves the office with little evidence of having had a cosmetic procedure
i often see people who went to injectors to have filler placed in order to camouflage the under eye bags
and these bags were simply too large to address with filler alone that’s just time and money being wasted
when under eye bags are too prominent to camouflage i recommend a surgical procedure called lower eyelid
blepharoplasty i find that most people i see who are interested in improving their lower eyelids become
familiar with this term through their online research some confusion occurs because surgeons offer different
opinions on the type of surgery and the type of anesthesia that they recommend let’s start with the type of
surgery the most commonly practiced approach to lower eyelid blepharoplasty is with a transcutaneous approach
this means that the surgeon operates on the lower eyelid fat pockets through an incision made below the
eyelashes in order to access the fat pockets the skin and supporting muscle is cut and separated before the fat
pockets are sculpted it’s common for the surgeon performing this type of procedure to remove skin with the
expectation that the wrinkled skin will look tighter afterwards as a specialist in primary cosmetic and
revision eyelid surgery i can attest to the fact that many patients who have surgery performed in this way are
at greater risk for problems such as lower eyelid retraction and ectropion partially due to skin shortage at
a minimum many people who’ve had surgery performed in this fashion report that the shape of their eyes change
in a way that is not characteristic of their original natural appearance they feel their eyes look too rounded
these types of results are due to compromise of the delicate anatomic support structures responsible for retaining
the natural shape of your eyes in addition the removal of skin under the eyes is based on an assumption that
there is excess skin in my experience most people don’t have excess skin but rather have a deficiency in their
skin quality in essence the skin appearance characterized by wrinkles and discolorations is due more to a loss
of skin quality and not an excess of skin quantity in my practice i perform most of my lower eyelid blepharoplasties
using a transconjunctival approach this means i approach the fat pockets to be sculpted from behind the eyelid
thereby avoiding any external incision this approach also allows for the preservation of the delicate structures
supporting the eyelid and maintaining your characteristically natural eye shape this procedure is considered
more specialized and technically advanced the art of performing this surgery isn’t how i sculpt the fat and at
the same time preserve fat so you can look as if you never had under eye packs my patients enjoy a more natural
appearance and not looking tired as they did before in order to improve skin quality i use devices and regenerative
technology for the purpose of refreshing the skin appearance and improving the skin quality through collagen
production i’ll routinely use a combination of lasers such as fractional co2 laser fractional erbium laser or radio frequency
instruments to accomplish this in order to further optimize collagen production and generate new blood supply
to the skin i also use prp or platelet-rich plasma platelet-rich plasma is a concentration of the wound healing
elements in your blood necessary when you have an injury like a simple cut i see a lot of patients who have
significant fat prolapse resulting in very large under eye bags oftentimes the patient is so concerned about
the bags under their eyes that they don’t recognize that the volume loss that was present below the bags as
well as the volume loss also affecting their cheekbones during consultation i’ll often suggest having cheekbone
or cheek enhancement with a long lasting hyaluronic acid filler at the same time of their surgery the technique
i employ is derived from surgical techniques used for placement of silicone cheek implants i use the term
structural volumizing for this as i’m able to create an improvement in volume and definition resulting in a more
youthful appearance with hyaluronic acid fillers this is in contrast to conventional approaches to filler
placement in the cheek area which is generally performed by placing the hyaluronic acid filler just below the
skin this approach ends up creating frequently a stereotypical rounded or pillowy look which is far from youthful
the results from addressing under eye bags as well as enhancing cheekbone appearance can be highly satisfying for
the patient as far as anesthesia is concerned I perform transconjunctival blepharoplasty with local anesthesia and
light iv sedation so many of my patients are comfortable and are able to recover very quickly my patients appreciate
being able to avoid the risks and recovery associated with general anesthesia you’re able to return to work in about
a week with minimal swelling or evidence of surgery as a specialist in cosmetic eyelid surgery i’ve been able to
help my patients with under eye bags improve their appearance non-surgically surgically and as well with the
combination approach since the appearance of your eyes has such a significant impact on how you’re perceived by
other people it’s important for you to understand these basic principles so you can make an informed decision
when you’re ready to take the next step i hope you found this information helpful thank you for your question

What is healing like after hooded eyelid surgery?

Upper eyelid surgery to improve eyelid hooding. To relieve sagging and redundant eyelid skin due to genetics or aging is commonly performed to help eyes appear more open and vibrant. Often both skin and underlying fat pockets are reduced to achieve an optimal result.

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 specialize in cosmetic procedures for the upper and lower eyelids. Including surgery for eyelid hooding, under eye bags, Asian double eyelid surgery. And I also perform specialized eyelid surgeries such as ptosis correction, restoration after thyroid eye disease. And revision procedures for eyelid surgeries originally performed by other doctors which ended up with complications.

In my mind the purpose of surgery for hooded eyes is to reveal the true shape of the eyes. Which is being hidden by the hooded skin. The hooding actually ends up defining the perception of the eye shape and can communicate unintentionally sadness, fatigue, and even anger or disapproval.

Understanding this goal of revealing the true shape of the eyes. Without making the eyes look too open is critical to performing an ideal procedure.

The amount of skin to be addressed and the amount of soft tissue. And the underlying fat pockets to be contoured is all done based on an artistic plan. The execution of this plan requires technical expertise with efficient perform of the upper eyelid surgery or blepharoplasty. I perform upper eyelid blepharoplasty in almost all my surgeries using local anesthesia with light sedation thereby avoiding general anesthesia.

This approach is comfortable for the patient and allows for faster recovery and minimal downtime. My patients return home right after surgery and typically go back to work in one week. As far as healing after surgery is concerned, the first 48 hours is about managing some swelling. I advise my patients to use cold compresses for 20 minutes on and 20 minutes off for the first two days.

I also prescribed antibiotic ointment for the sutures. The sutures are removed from the upper eyelids after about one week. Healing continues for about a year. However, generally speaking my patients look good for social events within one to two weeks after surgery.

Optimal healing is supported by a healthy lifestyle smoking, lack of sleep and poor diet can result in sub-optimal recovery. By the six-month point after surgery swelling has resolved. Enough for us to conclude that the appearance is close to the final result. However, full surgical healing can take about a year.

Recovery from upper eyelid surgery can be a lot shorter than many people assume. Using local anesthesia and light sedation combined with meticulous surgical technique and proper aftercare. Patients are back to work quickly and don’t have to wait long to enjoy their refreshed looking eyes. I hope you found this information helpful.

Thank you for your question.

Swelling after Asian eyelid surgery can make a lot people worry about their results.

I’ll explain how I help my patients for whom I perform double eyelid surgery

I’m Dr Amiya Prasad.

I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.

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

Asian Eyelid Surgery often referred to as double eyelid surgery is a procedure I perform routinely in my practice.

The term “Double eyelid surgery” can be used to describe both the non incisional technique and the incisional techniques.

Before discussing these concerns, it’s important to understand why the procedure is performed, what are the principle objectives of the procedure, how the procedure is performed and what the healing process is like before you have a more stable appearance.

The goal of this procedure is to create a crease or double eyelid fold where one doesn’t exist or when a crease is partially present and the desire is to have a deeper and more well defined crease.

Asians who have a natural eyelid crease or double eyelid have a connection between a muscle called the Levator muscle and the skin.

The levator muscle is the muscle responsible for lifting your eyelids.

The procedure options include one called a non incisional technique and the other being an incisional technique.

The main goal is to create a connection between the skin and a muscle called the levator muscle.

The decision to choose the non incisional or the incisional method in my practice is based on the presence or absence of excess skin or fat.

When I perform the non incisional method, I make strategically placed entry points in the skin and place sutures to engage the levator muscle and create a connection which results in a crease.

When I perform incisional surgery, I close the skin with sutures and use different ways to attach the skin to the levator muscle for the same purpose of creating a crease.

Swelling between the crease and the eyelashes is something that concerns a lot of patients.

In addition the effect of swelling often makes the crease look higher than desired and can make amyn people feel anxious.

Swelling can also be different between the two eyes which can also make someone concerned about looking uneven or asymmetric.

During the consultation, I educate my patients about the healing process which includes swelling and the timing for return to work, social engagements and when to expect a stable appearance.

One area of significant concern, especially in the first few weeks after surgery is the perception that the height of the eyelid crease is too high.

I often get asked by patients who’ve had surgery elsewhere about how soon a revision surgery can be performed because they believe, the surgeon had made the crease incision too high.

It’s important to understand that swelling between the eyelash and crease is temporary and that it can make the eyelid crease look too high.

Typically my patients go back to work in about 1 week. For incisional surgery, this is when sutures are removed.

As far as social events or events where your appearance is important, allow for at least 2 weeks or more.

It’s important to understand that swelling can be present and continue to decrease over several months to up to 1 year after surgery.

Generally, I expect appearance to by close to the final appearance around 6 months. If a patient has a history of allergies, sinus problems, smoking or other circulation issues, swelling can persist longer than is typical.

If there isn’t significant swelling after 6 months, revision surgery, if needed may be considered.

In the first 2 days after the surgery, cold compresses help decrease the initial swelling after surgery.

After the first 2 days, the clearing of swelling depends on the amount of swelling and circulation.

I encourage my patients to be up and about walking, talking and smiling and if they’re planning to be more sedentary, warm compresses can help.

Swelling and asymmetry after Asian Eyelid Surgery can be concerning.

In my practice, I help my patients through this process by seeing them at closely spaced regular intervals so I can make observations and continue to educate them about the stage of healing they’re in.

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

Can I Change my Eye Shape?

The eye shape is dependent on genetic factors which are specific to you.

These genetic factors include the dimensions and shape of the bones around your eyes as well as the prominence of your eyes and the architecture of the soft tissue and ligaments which support the upper and lower eyelids.

In our practice, when someone comes in requesting a change in their eye shape, we discuss several options however I always emphasize the importance of understanding that these procedures should be performed in a way which looks natural and looks right for your face.

Hi my name is Kelly and most of you may know me as Dr. Prasad receptionist but today I am his patient when I first started working here I believed in plastic surgery but I didn’t think that at the time I needed it after seeing Dr. Prasad patients I realized that I could actually be one of them it’s I know I’m 22 so for some people you’re like really eyelid surgery but it’s not about age and it’s not about what you look like it was something that I knew would make me happy

Kelly is young so there’s not a lot of aging changes so what we want to do is retain a natural appearance to her eyes and so and it first identify the crease this space right here is where you apply eyeshadow and so that will be the definition nature gives us a crease so that it is as you get older gets less defined but when you’re young is pretty well defined and some basically follow what’s already there as the starting point.

I knew that Dr. Prasad was the right doctor to fix that for me he is excellent at what he does he’s a master of his art and just like any artist could draw a picture Dr. Prasad can fix your eyelids

Now the art of eyelid surgery is deciding how much to do as well as how much not to do so when I’m looking at her I’m asking her to open her eyes and I like to do my drawings with the patient’s standing up because we’re vertical and when you’re laying down everything kind of shifts up and back so with her students getting up I can confirm that the crease is in a nice place based on what I saw with her eyes closed and now I look at her and see how much extra skin there is and skin is not the enemy it doesn’t going to remove all the skin what we want to do is to look young and natural so if we take off too much skin it can actually make you look older okay so what I’m doing now is measuring a certain amount of skin that I’d like to reduce and at the same time not take too much and this is where the art is because technically she has enough elasticity in their skin to be able to remove a lot more so we almost have permission to take away a lot but really we don’t because then she will look like she had surgery so what we want to do is to make her eyes look more open and nor natural and this is where experience and artistry are very very important essentially anybody can take away skin but taking you right about a skin away and doing in a way that looks nice and natural that’s judgment that is I feel intrinsic what I like to do is create enough space on the outer aspect of the eye so that you can really apply eyeshadow and it will look very nice at the same time we don’t want any scars that go outside of the natural shape of the eye if you go to any restaurant to look around the city or Long Island you’ll see a lot of people walking around with an incision line out here because the doctor when they did the surgery drew it in a way so that the scar went outside so again she’s young we don’t want her to look like she’s had surgery so with this design here it flows and tapers and it looks it matches his wife of her face it’s mental do the same thing on this side it’s important to realize when you look at eyes that know very few people have a hundred percent symmetric eyes and you realize that when you’re doing the drawing that the subtle or subtle asymmetries and wood Kelly her left brows a little bit higher than her right brow and bone structure has an effect on how these areas are manifested because the soft tissue where the skin drapes over the bones so compensating and trying to maximize the symmetry is also important but again we are naturally a little bit asymmetric so there’s a lot of heaviness on the outer aspect here there’s not much over here so it’s almost graduated we’re going to take a little bit more as we go out so that what everything is done you’ll actually have more of an eyelid do that Calvin yes nice so that’s that’s what we can expect okay all right so we get to work now

I am four days post-surgery it seems unbelievable to me I was literally fascinated with my results I’m back at work after four days which most people were even shocked about I got a call the next day from the nurse and she said when are you gonna be back I said Tuesday she said really I said yes and I knew would be possible because honestly I was stunned by the fact that I didn’t look like I had surgery um I went to wool bombs last night and nobody even looked at me like I was crazy which most people would think they would I am back at work feeling fine and I am ecstatic over my results they really look good really is it for one week I can’t believe it yeah yeah I feel like I’d literally I don’t look like I had surgery someone wouldn’t say hey did you have plastic surgery but I look different to myself and I’m so happy about that because it I have knowledge which I didn’t have before my sister couldn’t believe it she said she can’t wait to do my makeup which is exciting for her but I just wanted everyone to know that I feel great and I’m excited this is my month and a half post-op video I did my upper eyelids because I had a lot of extra skin and oh people are always saying you look tired or when I smiled I literally didn’t have an eyelid I would wear makeup and you couldn’t tell so I made the decision to do this and I’m so excited to be here talking to you guys about this because it has made such a difference for me the funny thing is that people will see me and nobody knows the difference my friends haven’t noticed family members that didn’t see me after the surgery haven’t noticed and it’s just like I like that in a way because he didn’t change my look he just enhanced it so I am so excited I’ve been wearing makeup every day basically because now when I do you could see the eye shadow my eyelashes are up my mascara looks wonderful and that’s just like something little that comes along with it and I don’t look as tired I feel like I look awake and enhance I don’t look different but I definitely look better and that is why I’m so thankful to Dr. Prasad for this if the upper eyelid surgery I had done gave me that natural crease that most people don’t have to have surgery to do but I was a person that did the skin that hung over prevented me from having an eyelid basically before the surgery one of the nurses said to me when you smile you know you don’t have that look that most people have so now I’ve gained that natural crease just from doing the surgery I’m actually an aspiring actor so for me that’s your looks is what sells you you need that in that business and I feel like Dr. Prasad gave me an opportunity to enhance my look and I’m very excited about that because you want to look your best it’s important you’re on camera people are looking at you that’s what they’re judging you by the first step you walk in the door so he gave me an opportunity to give them something a little better to look at I look a week I look alive I look like I’m ready to be there and like I slept last night which is important it’s something that everybody wants but especially someone whose look is something that you know is imperative in their career.

Today we’re doing a Vampire Facelift and we have a wonderful patient here today who is going to enjoy the benefit and we’re looking forward to helping her.

Hi I’m Laurie I’m at Prasad cosmetic surgery I’m very excited for my Vampire Facelift today I heard some wonderful things about the procedure a few of my concerns on my skin is the dark circles under my eyes also some fine lines on the side of my eyes and smile lines over here as well and I just want a rejuvenated refreshed look which I heard that this procedure will bring now before we start to do the procedure.

I’m going to talk a little bit about what it means to do a Vampire Facelift first of all for anyone who is a doctor or surgeon it’s important to understand that it’s not a regular facelift in terms of the definition of a facelift and that means a facelift helps the jowls and jawline as well as the neck skin by lifting all of the sagging tissue the terminology facelift has now been transformed to just mean facial enhancement so really this is more about restoring volume than it is about lifting so show me what you want to see change the hollowness under my eyes look at the darkness also okay as well as like like the creasing I’m walking directly mm-hmm so we want to see a little bit more volume and this is one of the things that happens and if we’re lucky we get old enough to have some of these problems but when we as we get older we lose fat we lose volume and so the cheek area and the under eye area start to look a little bit hollow so with the vampire lift we’ll be able to restore some volume in this area as well as in other areas of the face that look like they’re starting to get a little bit flat so is there any other parts of your face that you want we just focus on the creases on the side of the nose the smile lines the smile lines right so using using your own blood to create your own collagen using the vampire lip technique is really nice because your body is generating college and it’s a more of a natural tapered look compared to fillers sometimes because fillers can sometimes look a little bit bumpy and using your own blood it kind of goes in very smooth and it generates collagen over the course of several weeks to months so that’s really nice and it keeps on improving a Vampire Facelift was named that because it has to deal with removing some blood or harvesting some blood so that we can use the growth factors and platelets to help restore collagen it was created by a doctor named dr. Charles Reynolds who combined hyaluronic acid which is a filler like Restylane or Juvederm with platelet-rich fibrin matrix now platelet-rich fibrin matrix is different from platelet-rich plasma this is platelet-rich fibrin matrix that’s been activated with calcium chloride so now we’re going to do this one of the nice thing about platelet-rich plasma plug of interest the growth factors stimulate blood flow blood blood vessels and blood vessels go into your skin and create flush or youthful glow you know that’s what we want after the age of 30 is getting back some of that youthful glow and so unlike regular filler platelet-rich plasma or platelet-rich fibrin matrix will stimulate new blood vessels and that creates this nice glow that goes on for months the difference between platelet-rich plasma and platelet-rich fibrin matrix is that the fibrin matrix is a more stable form that allows the recruitment of these growth factors and it creates volume so if we will use a kit such as that Creek offered by self fill or region lab then the material that we’re using acts like a filler as opposed to platelet-rich plasma which is very effective but it’s a liquid and so if we wanted to add volume in the places that need volume it’s better to use something that has substance to it like a typical filler it takes a couple of days for the is to continue but you get the immediate gratification of having some volume and so that you can go on to dinner tonight and you can enjoy having all this placed without it looking like you have something done.

I am an event planner I need to always be on which is one of the reasons when I’m getting this done there’s no downtime with this procedure I need to always look my best and it continues to refresh and rejuvenate your skin so the results only get better which I am very excited about but as far as not having any downtime not missing any work and be able to be camera-ready for any kind of event I need to go to I think this is the right decision for me.

I think we can benefit from adding a little bit here to make this area look a little bit younger that nice yeah good yes no that’s enough shapes in it that’s a young face looking too different that was a sensitive area common in Saudi because that’s a good book no you don’t I mean like you really see huge different pictures which we have it yeah so again the Vampire Facelift is a designer procedure that was created by dr. Runnels so that we can combine in a very specific way the use of a hyaluronic acid and platelet-rich fibrin matrix with one particular goal in mind is to restore the youthful appearance by restoring volume in the places where volume is lost but at the same time making it very convenient it is no surprise that a lot of people who go for fillers will have a negative experience because they’ll have bruising all they’ll have swelling and it was the intention of this particular Vampire Facelift procedure is that once you have it done you can literally have it done as a last minute process so if you have a party that same evening or if you have an important event the next day then you can have a Vampire Facelift and look good.

I just have my Vampire Facelift about ten minutes ago I actually could see it’s amazing I could actually see the results already um plumpness in my cheeks just more volume on the lower part of my face and actually the hollowness under my eyes it’s basically gone already so it’s been a great experience actually going back to work now no downtime tiny little bit of redness but skin looks plump and great so I’m very happy you since I have my vampire face assisting and I love it almost like a refresh you say by skin the texture is much better I don’t have to wear any poor foundation definitely not resounding dark under the eyes and fine lines as well and definitely terrific going on.