Archives: Transcript

In my practice the essence of what we do is develop a bond with our patient it’s not just me but with my staff. So we get to really know who they are and they get to know us very well something that I did was ask a different set of questions and when I started my practice and now over the past 16 years I progressively developed systems and techniques so that my patients have very natural results and also quicker recoveries.

It’s very important to retain the character of a person’s face when I do a procedure and so restoring their appearance so that they look like themselves is so important we all have an image of ourselves in our minds eye and there’s often a disconnect as we get older or as some of the genetic changes start to occur in what we see in the mirror or in photos.

So what I try to do is to reconnect what we see in our minds eye or how we feel on the inside with how we look on the outside our office is certified by the Joint Commission and this is in line with my personal philosophy of taking care of every patient like my own family member. The Joint Commission is the same certifying body that certifies hospitals and surgery centers so our patients feel very secure about coming to our facilities and being taken care of by registered nurses and surgical techs and a team of professionals to ensure that they are safe when they’re having their aesthetic procedure when you contact our office you and I will work together to achieve the results that you are looking for.

What can I do to treat under eye dark circles?
Under dark circles are a fairly common problem that can affect people of all ages.
There are several causes of under eye dark circles which makes it important to have the
right strategy for your situation.
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’m well known as an eyelid specialist, and treat conditions such as under eye bags,
and hooded eyelids, as well as specialized procedures such as eyelid ptosis, revision
eyelid surgeries for complications originally performed by other doctors such as upper and
lower eyelid retraction, improving appearance after thyroid eye disease, and procedures
involving the lacrimal system.
I’m also well known for non-surgical eyelid procedures, such as the use of injectable
fillers for hollowing above and below the eyes, platelet-rich plasma to improve the
skin of the eyelids, and using different lasers to improve the delicate eyelid skin.
Dark circles around the eyes can make people look tired and weary, even if they actually
feel great, and have a lot of energy.
Having dark circles can give the wrong impression about you and how you feel.
In a world where first and lasting impressions are so important, it’s understandable why
people are seeking all kinds of solutions for this common issue.
Under eye dark circles can be caused by several issues:
Thin eyelid skin revealing the anatomy underneath the eyes such as the orbicularis muscle and
blood vessels Lack of fat and bone structure under the eyes
resulting in a hollow look, Ethnic pigmentation
Hyperpigmentation from previous procedures, such as laser treatment
Iron deposits from the blood circulation such as allergic shiners
Popular strategies used by many people is the application of over the counter creams
which make claims which they never live up to.
While creams can moisturize the skin, they are limited in addressing any other anatomic
issues which if addressed can result in more significant benefit.
Upper and lower eyelid skin is the thinnest in the body at 0.5mm thickness when healthy.
When eyelid skin becomes thinner from aging, sun exposure or smoking, the challenge is
to improve the quality of the skin without compromising the thickness.
With this principle in mind, I have focused more than 10 years on the application of regenerative
medicine technology, specifically platelet rich plasma or PRP.
I use platelet-rich plasma, or PRP, routinely to treat several causes of under eye dark
circles.
Platelet-rich plasma is the concentration of wound healing and growth factors naturally
present in your blood for when you have a cut.
When concentrated, it can be used as an serum to improve skin quality, thickness, and overall
skin health, while improving the blood circulation and blood supply in the area of treatment.
PRP is prepared from your blood, which is drawn in our office like you would have during
a routine blood test.
The blood is spun in a centrifuge to concentrate the platelets into a clear, yellow plasma,
which can then be drawn into a syringe.
The PRP is carefully placed under the eyelid skin.
The regenerative process of this treatment is continuous, as increased blood supply and
healing factors work after the injection to improve skin quality and thickness, stimulate
collagen, and increased circulation.
In cases where the under eye area has concurrent hollowing, I can combine the placement of
PRP with the deeper placement of a hyaluronic acid filler like Restylane to add volume.
This combination treatment has a synergistic effect as both hollowing and skin quality
are treated.
For optimal, results, PRP is performed with regularly scheduled sessions.
The frequency of these sessions depends on the conditions being addressed such as sun
damage, wrinkles, and discolorations.
PRP application helps change
Lasers can also help with improving skin quality under the eyes, through resurfacing of the
epidermis and collagen stimulation in the dermis.
Lasers must be used carefully to avoid potential overtreatment which can result in thinning
of the under eye skin further, and possibly causing problems with pigmentation.
When lasers used appropriately, they can be quite effective.
I routinely combine PRP with laser treatments to reduce to create maximal synergy to achieve
best results.
Depending on the techniques employed, there is generally very little healing time with
PRP treatment.
Laser treatment for eyelid skin such as smooth eye long pulse erbium laser can be performed
with no downtime.
Fractional lasers such as fractional erbium or fractional CO2 laser may require a few
days before the skin heals over.
This means that most patients can go back to work right after PRP treatment and some
laser treatments with basic precautions related to sun exposure and skin protection.
A common question which comes up about every skin treatment is “how long will it last”.
The answer is, it depends.
The collagen response of your skin is affected by age, extent of sun damage, wrinkling and
pigmentation as well as your lifestyle such as smoking and amount of time spent in the
sun.
I evaluate every patient and develop a customized treatment plan for them based on these and
other important variables.
Dark circles can be treated without surgery, and results can really last.
It’s important to note that ethnic pigmentation cannot be taken away, but you can improve
skin quality so your eyes look more vibrant.
As is important for any aesthetic procedure, knowledge and experience is important.
In my experience, combining regenerative medicine technology such as PRP with advanced laser
and radiofrequency technology has been successful for my patients.
I hope you found this information helpful…thank you for your question.

Thank you for your question! You stated in your question that you’re using 15% minoxidil and you’re asking if minoxidil can actually damage or kill transplanted hair. And you’re noticing that after the course of one year, that you have fewer transplanted hair. Well, I can give you some guidance on this question. I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years. Hair transplant has been a big part of my practice for this time.

And in addition, I’m the founder of Trichostem™ Hair Regeneration centers, a non-surgical treatment alternative for hair loss using a wound healing technology that we developed in our practice. So I can certainly speak with a lot of experience about situations like yours. Now of course, in your question, unfortunately, I don’t have the complete story as to the timing of when you had the transplant, when you started using the 15% minoxidil and what that may mean when you observed fewer transplanted hairs but let’s start first of all with the question why be on 15% minoxidil.

I realize that there are a certain percentage of our colleagues who believe on these custom formulations and certainly, in our practice, we have tried these various formulations. The idea is that if we can’t get something which is like over-the-counter like a 5% minoxidil, we believe that there is value in using a higher percentage, then you get these custom or compounded pharmaceuticals created and provide them to patients. So I’m not necessarily denying any potential benefit but let’s say we’re talking about the transplanted hair one year after transplantation.

You’re always looking at a slice of time and it may not be that the minoxidil is causing the hair grafts to shed and not come back but it might be that you caught the transplanted hair in a particular stage in the growth cycle. To understand this, let’s just go over the basic hair growth cycles. There’s the anagen phase which is the active growing phase. There’s catagen phase, the intermediate phase where the hair is still present but it’s no longer actively growing and there’s the telogen phase where the hair sheds. During the telogen phase, there are 3-4 months of lag at a minimum before new hair growth occurs. So in our practice, when we do these surgeries but as of late, we have actually been doing a lot more of a treatment called Hair Regeneration. I’m just going to give you the context of how minoxidil fits into this equation.

As far as I’m concerned, minoxidil does help people with hair thinning because it appears to prolong the growth cycle of thinning hair which means that the hairs that are thinning progressively at least stay a little bit longer. It’s important to understand, going back to the growth cycle, the anagen or the active growth phase decreases with hair thinning and the telogen actually increases which means you shed a hair and then you don’t have the hair to replace that hair for a longer period of time and when that hair comes in, it’s thinner.

When we do this treatment called Hair Regeneration, we figured out that essentially for people with thinning hair, once they have the treatment, essentially the hair has stopped thinning. In other words, we no longer need the benefit of minoxidil. And I’ve been doing this for many years and so I have a lot of clinical data in fact we have patients who come to us from all over the world and we really rigorously collect a lot of information with every visit when we see our patients for microscopy photos, standardized position photos of the top of the head and various views and digital photography.

And I’ve made observations because a lot of times, people have been using, with thinning hair, minoxidil for a long time and sometimes it becomes a security blanket. What I have observed that for a lot of our patients, I’ll actually stop the minoxidil about a month or so after the procedure if the patient wants to. Sometimes, people just want to stay on their regimens until their hair starts to regrow and they see it and they’ll stick with the regimen they were doing before the treatment.

So I think that, in that respect, transplanted hair by definition is not hair that should be thinning. Now, of course, we can have a long discussion about the source of hair in procedures such as FUE grafts but let’s say you had a standardized FUT or strip surgery or even an FUE. Those hairs are genetically resistant to shedding. Therefore those hairs should actually be fairly resilient and be able to grow but something that not everyone fully appreciates is that a certain percentage of the hair grafts don’t actually make it.

They don’t continue to grow. There’s a certain loss. We’ve seen patients who come to us for surgery who had megasession procedures and they lost 90% if their grafts done elsewhere and we were left with much less hair to work with to do surgery. So it is a potential. In the case of FUEs, approximately 30% of hairs are actually transected which means that those hairs don’t actually have the root when they’re placed so they can actually shed and go away. So I think you need to speak to the doctor who performed your surgery and the doctor who is prescribing the 15% minoxidil and get an orientation of what’s going and why you should continue using minoxidil.

If it’s to maintain your existing hair, well it might be that the minoxidil itself maybe inflammatory or irritating to the scalp and it might be causing some breakage or some potential shedding of the hairs but not knowing what the vehicle is or method in which the minoxidil is being delivered in terms of the formulation, I can’t just say that that’s certain.

So you have a reason to be concerned and I think that discussing this with your doctor, reviewing your photos. You know, when we do surgeries, we do a plan, we take pictures immediately after surgery, we take pictures throughout the follow-up period. It’s just what we do just to track progress and if there was hair in a certain hair and there isn’t hair now, it might not really be a minoxidil issue or an inflammatory issue but at least be able to document what it looks like 3 months from now, 6 months from now, 9 months from now. It may be that these hairs are just temporarily not growing but again, without more detailed information, I can’t give you a more definitive answer. So I hope that was helpful, I wish you the best of luck and thank you for your question!

Why are creams not working for my eyebags? The presence of eye bags is a common problem that affects people regardless of age gender or ethnicity eye bags are typically caused by genetics has often seen in younger people or age-related where fat around the eyes prolapse is forward the initial response of many people is to buy a bunch of under eye creams that claim to get rid of eye bags I’ll explain why I creams do not actually work for under-eye bags.

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial or oculoplastic surgeon I’ve been practicing in Manhattan and Long Island for over 20 years my training was first in eye surgery after which I pursued advanced training in cosmetic and reconstructive surgery of the eyelids I treat eye bags every day in my practice I also specialize in managing complications of eye bag related procedures performed by other doctors as mentioned earlier eye bags can be seen at any age I’ve treated three generations of the same family for eye bags the youngest patient I retreated was 14 years old and many people who come to me are in their 20s and 30s and have been aware of puffiness under their eyes since their teens this under-eye puffiness is always present and makes one look tired and older is caused by a condition referred to as lower eyelid fat prolapse.

This means that the fat normally around your eyes has pushed forward creating a bulge this is why it’s called lower eyelid fat prolapse or herniated fat this differs from temporary causes of bags such as fluid associated with allergies sinus problems soft intakes and hormonal fluctuations while these can all cause puffiness they are usually intermittent these temporary causes can also make the under eye puffiness due to fat appear much worse creams which claim to eliminate under-eye bags don’t work because they cannot physically reach the deep fat pockets and have any effect the best way to fully correct eye bags is through surgery to sculpt and remove the displaced fat pockets cosmetic eye creams however can improve quality texture and color of the skin under and around the eyes.

I developed some skin care products which are designed for this purpose there are basically two strategies to help improve the appearance of under-eye bags if someone has slight fat prolapse pushing forward and has a certain anatomy of the bone structure under the eyes we’re in a space called the tear trough fillers such as Restylane or Juvederm can be used to blend the transition between the elevation of the fat pocket and the hollow of the tear trough this approach to camouflaging lower eyelid fat with filler has been very useful in our practice to help patients with minimal fat prolapse or under eye puffiness if someone has more severe eye bags the more definitive treatment is a surgery procedure called lower eyelid blepharoplasty most general plastic surgeons perform this procedure with an incision in the lower eyelids right beneath the eyelashes and sometimes remove lower eyelid skin in attempt to improve wrinkles this approach is called a transcutaneous blepharoplasty.

I see a lot of patients who have had this procedure they come in complaining of losing the shape of their eyes the lower eyelid is pulled downward I also see a number of patients who have had complications from this procedure like lower eyelid retraction and lower eyelid ectropion these conditions result from skin shortage under the eyes and compromising of lower eyelid support my procedure of choice is called transconjunctival blepharoplasty I feel this approach is a minimally invasive procedure that allows me to address under-eye fat pockets surgically from the inside of the eyelid there is no external incision or any effect on the supporting structures of the lower eyelid.

I essentially reduce and reshape the fat to address the puffiness so you no longer have bags under your eyes while maintaining the natural shape of your eyes the goal is to appear as if you never had I bags this is very highly successful procedure with faster recovery that allows my patients to return to work in about a week we routinely perform this procedure under local anesthesia with light sedation in our certified facilities in both our offices for many patients who come to us from all over the world for this procedure they like that they don’t have to go to a hospital surgery center and can be comfortable having the procedure done in our office and they go home soon after surgery not employing general anesthesia makes patients more comfortable and makes their recovery much faster since they’re not recuperating from the effects of general anesthesia.

If eye bags are your concern don’t waste money on creams when you understand how the underlying lower eyelid anatomy of the fat pockets which have prolapsed forwards are responsible for these under-eye bags buying creams as a treatment doesn’t make sense I recommend you meet with qualified and experienced cosmetic surgeons to learn about your options which are filler placement to camouflage or surgery which is more definitive I hope you found this information helpful thank you for your question.

How long do cosmetic fillers last?
Cosmetic fillers are very effective non-surgical solutions for facial volume issues
such as hollow under eyes lip enhancement cheek definition the lack of chin projection and other problems
related to genetics or age-related volume loss cosmetic fillers can also
treat other issues such as wrinkles lines and folds as well as acne scars
and even thinned earlobes although filler can be used for many
situations some people have reservations about
filler treatment because of concerns about the longevity and about using
something they think is not natural in their body I’ll discuss how I counsel my
patients who have the same questions and concerns about fillers in my practice
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years as an eyelid and
facial cosmetic surgery specialist I’m well known for my work with injectable
fillers in the delicate upper and lower eyelid area as well as deeper placement
of fillers in the facial bone structure for more natural looking results
applying a technique called Structural Volumizing people often want to improve
their appearance caused by loss of volume as we get older our faces
gradually lose bone muscle fat and soft tissue in some younger people a genetic
lack of volume in the face such as in the cheeks and eyes make them look older
and more tired than they actually are facial volume loss can also be seen in
people who are very athletic who have very low body fat this can also be seen
if you’ve lost a lot of weight from diet or weight loss surgery a lot of people
who we see come in requesting fillers which are permanent so they can avoid
having to come back regularly for filler placement in my surgical practice I’ve
had patients come from around the world to have me remove permanent and
semi-permanent fillers such as silicone and poly acrylamide in addition if an
infection such as a biofilm were to occur in its with a semi-permanent or
permanent filler they would have to be removed surgically the reality is that
you can never completely remove this filler material which means that the
possibility of recurrent infections will be more than likely in my practice for
any procedure my recommendations are based first on minimizing risk and being
able to address any issue that may potentially arise quickly and safely I
don’t recommend the use of permanent or semi-permanent fillers further as aging
progresses these fillers will not easily adapt to changing anatomic relationships
there are more than a few celebrities who have publicly expressed regret about
having permanent fillers particularly in their lips in any discussion about a
natural filler the subject of fat grafting always comes up in order to
address facial volume loss at the bone level fat grafting simply cannot be used
fat grafting is placed under the skin which makes it similarly susceptible to
the same issues as superficial filler placement
healing from fat grafting is unpredictable with frequent complaints
about lumpiness and asymmetry fat grafting simply does not meet my
criteria for predictability and benefit from the placement at the bone level my
preferred injectable filler material is hyaluronic acid hyaluronic acid fillers
meet my criteria for safety predictability versatility and
reversibility hyaluronic acid fillers occur naturally in the body which
significantly lowers the risk of foreign body reaction seen with permanent or
semi-permanent fillers hyaluronic acid fillers come in a range of thickness and
longevity allowing me creative flexibility to help my patients look
their best hyaluronic acid fillers are also reversible as they can be dissolved
with the injectable enzyme hyaluronidase how long hyaluronic acid fillers lasts
depend on structure and composition of the filler as well as an individual’s
rate of metabolizing the material I use softer hyaluronic acid fillers in the
under eye area for hollow looking eyes and to camouflage minimal eye bags
further I also use it for the enhancement of the lips these fillers
include Restylane L and Restylane Silk Juvederm Ultra a filler like Juvederm
Vobella can be used for vertical lip lines above
the upper lip these fillers last anywhere between 6 to 12 months before
they are fully metabolized and need to be reapplied I often combine fillers in
the under eye area with platelet-rich plasma or PRP a concentration of wound
healing and growth factors derived from your own blood
PRP helps improve the skin quality and skin thickness under the
as well as improved discoloration and pigmentation which is often seen
accompanying hollowing which is often described as dark under-eye circles
PRP often extends the effective life of filler under the eyes and the two
materials work well together fillers in a medium thickness and viscosity are
often used for the nasolabial folds the folds around the upper mouth and lower
nose often refer to as parenthesis lines in addition the mesolabial folds
the folds around the lower mouth also called the marionette lines these areas
have thicker skin but still have a fair amount of active movement when smiling
and talking both of these types of folds around the mouth become deeper due to
volume loss associated with aging these types of fillers that can be useful in
this area include Restylane Refyne Restylane Defyne which can last about
six to twelve months a filler like Juvederm Vollure also be used and lasts
about eighteen months the thickest hyaluronic acid fillers can be used on
bone structure and an area which doesn’t really move with facial expression areas
where I use these thicker fillers include the upper cheeks the jawline and
the chin these areas are pro to bone loss which naturally occurs with aging
the cheeks appear to deflate due to diminishing cheekbone structure as well
as loss of muscle and soft tissue the jawline may appear to sag and lose
continuity due to hollowing of an area called the mandibular notch the chin can
lose projection as bone continues to decrease I prefer to use a filler like
Juvederm Ultra Plus which can last about a year and Juvederm
Voluma which can last up to two years a filler like Restylane Lyft can also be
applied in these areas and can last up to 18 months successful
placement of facial fillers for diminishing facial volume at the cheeks
chin and jawline is highly dependent on technique most doctors placed these
fillers more superficially at the dermal and fatty tissue layer at this level the
skin cannot support a significant volume and can actually be weighed down by the
filler the fillers can shift and make the face look doughy I use my experience
as a facial cosmetic surgeon with extensive work in placing facial
implants to place fillers at these deeper layers which are on top of the
bone structure and under the muscle layer for more natural-looking results
this technique is called structural volumizing and is a technique practiced
by very few doctors it results in a more defined and balanced facial structure
and can even have a lifting effect by restoring volume at the bone structure
level the skin and soft tissue that may appear to have collapsed and descended
due to volume loss becomes more defined and the overall effect can produce a
vertical lift Structural Volumizing requires more filler than traditional
filler placement as the material is placed at the foundational level of bone
where most of them volume loss occurs therefore more volume is necessary at
this level results can actually last longer than more commonly performed
superficial filler placement this is an exciting time for people interested in
improving their appearance with safety predictability and convenience in my
practice the use of hyaluronic acid fillers has been a great tool for me to
help my patients I would remind anyone considering having fillers to understand
that fillers are just tool or materials used in the hands of a
sculptor the doctor’s expertise experience and artistry are critical to
achieve the best results for you recognizing that filler placement needs
to be done at regular intervals it’s very important for you to find a doctor
who you feel comfortable with this means someone who shares your aesthetic vision
who communicates well and makes you feel at ease I hope you found this
information helpful thank you for your question

How can I treat lines around my mouth?
There are three common types of lines around the mouth area that occur with facial aging
that patients and our practice often expressed concern about one vertical lip lines or wrinkles
above the lips to nasolabial folds also called parentheses lines that appear at the outer part
of the mouth and taper into the nose area and three mesolabial folds which become more visible
on the outer lower corners of the mouth often refer to as marionette lines these lines and folds
are due to tissue changes associated with facial aging such as a decrease in facial volume from
loss of bone fat and soft tissue as well as a reduction in skin thickness and quality I’ll talk
about how I help my patients with these lines around the mouth in my practice I’m dr. Amiya Prasad
I’m a board-certified cosmetic surgeon and fellowship trained oculofacial plastic and reconstructive
surgeon I’ve been in practice in Manhattan and Long Island for over 20 years helping my patients
with changes seen with facial aging is a core focus in my practice with particular emphasis on the
lips and the area around the mouth referred to as the perioral area vertical lip lines is a term which
refers generally to lines which appear above the upper lip these lines result from several contributing
causes this means that each cause should be approached to get the most effective outcome deep lines that
appear when the lips are puckered are caused by the activity of a muscle called the orbicularis Oris
muscle the appearance of these deep creases can be improved by strategically reducing muscle activity
using a neurotoxin like Botox as the activity of the muscle decreases the depth of the creases improve
with consistent use of a neurotoxin over time the skin continues to be less creased with movement and
the lines become less prominent a neurotoxin like Botox takes about three days to take effect and full
effects are seen about two weeks I routinely see my patients at that time to evaluate the results and
see if any enhancement is needed The effect of Botox or any neurotoxin decreases over several months so
patients come in on an average of about every four months vertical lip lines can also be due to volume
loss of fat and soft tissue beneath the skin volume loss due to aging causes loss of projection above the
lip resulting in lines increases to be more visible by placing a hyaluronic acid filler like Restylane or
Juvederm for a volumizing effect the skin is lifted slightly making the lines and creases appear more
smooth filler application can be performed in a few minutes and can last between 6 and 12 months vertical
lip lines can also be caused by diminishing skin quality the skin can lose collagen and elasticity due to
aging to stimulate collagen and tighten the skin treatment like laser resurfacing or radiofrequency heating
can be employed to induce a controlled injury response the body reacts to this controlled injury by producing
collagen to heal this area the collagen response can also help smooth and skin and thereby improve the vertical
lip lines the nasolabial folds or parentheses lines appear to deepen due to volume loss associated with aging
the nasolabial fold can be improved indirectly by adding volume to the cheek as well as to the mid-face I
add volume to these areas using a technique called structural volumizing also called the y lift where thicker
hyaluronic acid fillers are placed at the bone level which is below the muscle layer this method restores
volume where volume loss is most significant which is at the bone level unlike commonly practiced filler
placement which is just below the skin deeper placement prevents filler from shifting thereby avoiding the
doughy less youthful appearance seen commonly with traditional filler placement techniques in addition this
structural volumizing technique also has a lifting effect that further softens the appearance of the
nasolabial folds this Structural Volumizing technique came naturally to me as a surgeon with extensive
experience in performing facial implant surgery and facial fracture repair so instead of placing silicone
implants on top of the bone I place long lasting injectable fillers using thicker hyaluronic acid fillers
like Juvederm Ultra Plus and Juvederm voluma the results of this procedure can last one to two years the
lines and fold to start at the corners of the mouth and go downward are called mesolabial folds also known as
marionette lines these folds are also due to volume loss caused by aging and are often treated at the same
time as nasolabial folds we treat these lines with hyaluronic acid fillers like Juvederm Ultra Plus and
Juvederm voluma one particular advance of hyaluronic acid fillers is the ease of reversal that is they
can be dissolved with the enzyme hyaluronidase if someone is dissatisfied with their results this is an
important differentiation because for this area we can also consider a filler like radius which is made up of
calcium hydroxyapatite a material similar to bone which is also a long-lasting filler however radius cannot
be dissolved we further addressed the mesolabial fault by adding volume and contour to the jaw line also at
the bone level with Structural Volumizing the jaw line up to the chin tends to lose its continual contour and
definition with age and this can also affect the appearance of the mouth by adding filler to the jaw line all
the way to the chin to make the contour more continuous and defined the volume correction can also improve the
appearance of mesolabial these filler treatments take minutes to perform and patients can see improvement
immediately there may be a little temporary swelling after treatment but this is generally minimal and
resolves quickly I regularly see cosmetic filler patients two weeks after treatment to see how the filler
has settled and if any additional enhancement is needed patients can even have this type of treatment done
shortly before an important event like a wedding in my opinion filler placement is to be treated as seriously
as surgery once you’ve entered below the skin in my mind the procedure is invasive fillers are often applied
by non physicians and doctors who don’t perform surgery as I mentioned earlier I feel that my experience as
a surgeon has been very useful in how I place fillers particularly at the level allowing my patients to have
consistently satisfying outcomes with minimal swelling and rarely experiencing any bruising I hope you found
this information helpful thank you for your question

How long does facelift recovery last?
The facelift has been the gold standard in cosmetic surgery
for surgical facial rejuvenation to address sagging cheeks
and neck skin for many people it’s what first comes to mind
when thinking of cosmetic surgery and it is assumed to
require a long healing time for years face lips were viewed
as an exclusive procedure done by wealthier people who
didn’t mind a prolonged recovery process until they were
ready to reveal their new face to the world in my practice
I’ve developed strategies to help my patients have the full
range of facelift procedures with minimal risk minimal downtime
and quicker recovery I’m Dr. Amiya Prasad I’m a Board-certified
facial cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon I’ve been in practice in
Manhattan and Long Island for over 20 years during my training
in facial cosmetic surgery the facelift surgery involved general
anesthesia overnight hospital stay a large dressing drains a
lot of swelling and weeks of not so comfortable recovery at
that time I began thinking of ways to make facelifts be less
difficult for patients to experience with a shorter recovery
time without sacrificing the results and the longevity t he
first thing that contributes to longer facelift recovery is
general anesthesia for many people who undergo general
anesthesia recovering from the effects of general anesthesia is
equal to or worse than recovering from the surgery itself side
effects from general anesthesia include nausea vomiting and
lightheadedness patience after having general anesthesia are
often required to stay at a facility with nursing care overnight
and have a large facial bandage with drains when I perform facelift
surgery I use local anesthesia with LITE IV or intravenous
sedation rather than general anesthesia the patient is more
comfortable with a twilight-type of sedation throughout the
procedure we perform surgery within our own office facilities
which are certified by the Joint Commission after surgery patients
only need to stay in our office for about an hour or two before
returning home a light facial dressing is used without any drains
basic aftercare involves putting antibiotic ointment where the
sutures are placed and these sutures are removed after one week
patients can return to work in about a week to two weeks after
surgery the same standards for surgery ranging from limited mini lifts
to extended face and neck lift surgery are applied the deeper tissue
often referred to as the muscle is addressed the same way as any facelift
procedure performed under general anesthesia this layer of tissue is called
thus masked which stands for superficial musculo aponeurotic system I
perform the full range of facelifts from short scar mini lifts to SMAS
flaps and deep plane facelifts speaking of deep plane facelift it’s
important not to be overly impressed by doctors claiming to perform deep
plane facelift exclusively to imply that they know techniques that other
surgeons don’t in fact all experienced face of surgeons are trained in
all face life techniques less aggressive facelifts such as short scar
face lift is not actually a shortcut procedure but it is appropriate
for people who want to lift a sagging jawline but don’t have significant
laxity of skin and deep tissue under the chin on the neck a deep plane
facelift is actually another procedure performed by experienced facelift
surgeons which involves undermining and tightening the deep tissue
layers beneath the skin and thus masts the face and neck lift is a
procedure typically suited for older patients who have significant
laxity in the neck and under the chin so a longer incision is needed to
lift the face and neck at the same time I regularly performed these more
involved face and neck lifting procedures for my patients and still able
to get them back to normal life in a week to two weeks another way I
expedite facelift recovery is with advanced wound healing methods I apply
the wound healing material extracellular matrix or Acellular matrix which
consistently helps the incisions heal faster and make them virtually
imperceptible even after about a month recovery time is important but
recovering quickly doesn’t matter if you don’t like the results from
eyelid surgery – facelifts I approach all my patients and their procedures
with a natural aesthetic I believe my patients should always look like
themselves after any procedure and in the case of facelifts a version of
themselves which looks five to ten years younger in my practice recovery
from facelift surgery is optimized by using local anesthesia with sedation
efficient and meticulously performed surgery and the use of advanced wound
healing technology I hope you found this information helpful thank you for your question

How long will results eyelid surgery last?
One of the most common questions for people considering cosmetic eyelid surgery is how
long will the results will last.
The answers to this question depends on several factors which I’ll discuss.
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.
Upper and lower eyelid surgery with their various techniques are at the core of practice
as a Cosmetic Oculofacial Plastic Surgeon.
Oculoplastic or Oculofacial Plastic Surgery is a medical specialty which requires training
first in ophthalmology or eye surgery, followed by fellowship cosmetic and reconstructive
eyelid surgery.
Cosmetic eyelid surgery can be divided into procedures for the upper eyelids and procedures
for the lower eyelids.
For the upper eyelids, the most popular procedure is to address excess or redundant skin as
well as fat pockets referred to as upper eyelid blepharoplasty.
For the lower eyelids, the most popular procedures are to address puffy under eye bags and skin
wrinkling and discoloration referred to as lower eyelid blepharoplasty.
In cosmetic upper eyelid surgery, redundant skin, usually from genetics and the effects
of aging is excised to relieve the hooded look and reveal the natural shape of the eyes.
There are specialized procedures I perform such as Asian double eyelid surgery where
very little skin is typically removed for incisional surgery or no skin is removed in
non incisional surgery.
In terms of lower eyelid surgery, under eyebags are the main reasons people come for consultation.
Under eye bags are caused by fat normally around the eyes moving forward resulting in
what’s referred to as fat herniation or lower eyelid fat prolapse.
This condition can occur genetically as early as the teenage years and throughout your life
with aging.
When I speak to my patients about the longevity of a procedure, I explain that specific fat
pockets removed cannot come back.
However, with aging, other fat pockets can also prolapse and affect your appearance later.
As far as upper eyelid skin is concerned, I explain how it takes many years for the
skin to stretch.
However, other changes occur such as the brows drooping which can contribute to the appearance
of fullness over the eyes.
As a general principle, I say the benefits of eyelid surgery lasts about 5-10 years.
The effects of eyelid surgery can be affected by your age at the time of surgery, your environment
and your personal lifestyle.
For example, the longevity of the benefits of eyelid surgery for a 30 year old who avoids
excessive sun exposure and is a non smoker committed to a healthy lifestyle in comparison
to a 60 year old smoker who spends a lot of time in the sun.
Having been ipractice over 20 years I can attest to the stability of the results which
on average exceeds 10 years as has been reported by patients who’ve come in more than 10
years after eyelid surgery for other procedures such as structural volumizing or facelift.
Similar principles apply to Asian double eyelid surgery.
I would emphasize that when it come to eyelid surgery, technique and process of procedure
and after care are critical to long term satisfaction.
As a specialist, I’m well known for performing revision eyelid surgery for less than optimal
outcomes for patients who come to us from around the world.
I have developed strategies to allow my patients to have their procedures performed more safely,
comfortably and with faster recovery with minimal downtime.
For example I perform surgery with local anesthesia with LITE IV or intravenous anesthesia in
contrast to many doctors who use general anesthesia.
My approach significantly reduces the risks of systemic complications as well as post
surgery nausea and vomiting seen frequently after general anesthesia.
One area where it can be significant in terms of longevity and stability is the lower eyelids.
I frequently see patients who had their lower eyelid surgery done elsewhere only a few years
prior who are complaining about still looking tires and having eye irritation.
Typically this is the result of lower eyelid surgery performed from the outside with the
incision below eyelashes.
Skin is removed and the support of the lower eyelid is compromised resulting in lower eyelid
retraction.
Correcting this problem requires advanced reconstructive techniques including grafts
and eyelid support surgery.
In contrast, I perform lower eyelid surgery with a technique called transconjunctival
blepharoplasty.
I address the fat pockets causing the under eye bags form the inside of the eyelid and
protect the support structures.
What this means is that the patients are happy with the outcomes and maintain the natural
shape of their eyes.
Ultimately, this contributes to the longevity of the procedure.
The benefits of upper or lower eyelid surgery lasts for many years.
Age and lifestyle are important variables when you think of how long these benefits
will last.
Eyelid surgery, like many cosmetic procedures, can take years off your appearance, while
maintaining a natural look and preserve your unique facial character.
I encourage my patients to focus on healthy lifestyles as well as other less invasive
procedures which can help maximize the appearance of their eyes for many years after surgery.
I hope you found this information helpful…thank you for your question.

[Music] What’s the best lip filler?

The desire to have more attractive lips makes billions of dollars for companies in the business of selling lipstick fuller lips are generally appreciated as desirable and youthful

However the most significant concern for anyone interested in lip volume enhancement who I see in my practice is the fear of looking like a duck

They often will tell me how they or someone they know got a particular product placed into their lips and that they ended up looking crazy which then leads to the next question what’s the best lip filler

I’ll discuss the products I use in my practice and why the question what’s the best lip filler is the wrong question to ask

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 throughout my career I have used a wide range of non-surgical and surgical procedures to enhance lips this includes the original collagen injections such as zai plastun zai derm as well as surgical implantation of fat as well as tissue harvested during facelift surgery called dismiss and as well as commercially processed human tissue that all changed after the introduction of hyaluronic acid fillers in the United States in the mid-2000s

Whether it’s for lips or any other area it’s important for consumers to understand that the producers of hyaluronic acid products are creating through advertising a perception of product as being more important than anything else this includes the qualifications of the person actually performing the procedure since the companies are not subject to any licensed professional standards they don’t care who uses their product

What only matters to them is for consumers to ask for their products by name this is a problem the general public looks for the product without understanding the more important details of who is actually doing the procedure this has turned out to be disastrous with so many avoidable complications resulting in disfigurement and even death from filler injection think about it when a disastrous event occurs the person experiencing the problem is no longer content to look for someone like the person who injected them but rather for the highest level physician or surgeon to save their face and even their life

As I stated earlier someone like myself who’s performed so many different live procedures both non surgically and surgically over 25 year career has a deeper understanding of what to do and more importantly what not to do then a nurse or a physician’s assistant that’s obvious

I approached lip filler placement by first hearing from my patient what bothers them the most about their lips or what they want to see enhanced or accentuated typically my patients who are experiencing normal age-related changes focus on vertical lip lines thin lips and downward turning of the outer corners my younger patients tend to focus mostly on lip volume and lip border accentuation the purpose of volume enhancement

I like the softer hyaluronic acid fillers hyaluronic acid fillers come in a range of essentially different levels of thickness for example I perform a cheek volume enhancement at the bone level using a unique technique to deliver the material and create significant improvement in cheek definition for this objective

I use thicker hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm voluma for lips are used softer hyaluronic acid fillers such as Restylane Restylane silk Juvederm Ultra XC and Juvederm variably these less viscous fillers that are preferred for the lips as their physical properties allow for more natural movement such as talking kissing and smiling generally the softer and less viscous

The filler the more the material can adapt to the constant facial movement but it also doesn’t lasts long in order to reduce the probability of complications

I approach non-surgical treatments like injectable fillers the same way I approach surgery may not have thought of this but as soon as the skin barrier is entered the treatment is invasive therefore subject to many of the same potential complications as surgery lip enhancement begins with planning and having a shared vision between the patient and the doctor for a desired result my style is to create balance with the other facial features

So lips look better but don’t look like they don’t match the rest of the face something worth mentioning is that a growing number of men are actually coming in and during an overall facial evaluation are recognizing that subtle lip volume correction can be natural and masculine social media platforms which are driven by attention and in particular shock to generate more attention have created in some ways a new aesthetic which is appealing for some people I’m not one of those people

I see too many younger people with the naturally full lips show themselves being injected and end up looking exaggerated a patient will ask why a particular celebrity who can afford the best doctor can have such large and artificial looking lips

I explained that it’s mainly because that the celebrity and their doctor share the same exaggerated aesthetic ideal in other people their lips look large and overdone due to the combination of choices the choice of material by the doctor a complication and of course choosing a low-cost medical provider who rushes to make up for money lost in discounters that’s particularly scary you really do end up getting what you pay for

I’ve always believed in every face having a unique character that should be preserved whenever any aesthetic procedure is performed there is a difference between enhancing or accenting and exaggerating this is why making a choice of doctor comes down to expertise and artistic style

I also believe in the importance of communication skills and empathy as an artist I tend to apply the golden ratio which is a proportion of 121.6 and it’s found in nature in many beautiful things the golden ratio notwithstanding I customize to ethnicity and my interpretation of an optimal balance as many patients request a less-is-more approach

I apply a conservative volume of filler for subtle enhancement I use cannulas and my objective is to minimize the times that the skin is poked to minimize bruising and swelling so that my patient can go back to their day without any issue this is in contrast to celebrity doctors on TV and social media who are perceived as experts who use multiple pokes through the lips to add filler it’s important to understand that every entry point of the needle through the lips is a possible risk of more bruising or lumpiness that requires additional recovery time or even potentially needing to dissolve the filler and redo the procedure as far as follow-up is concerned

I routinely see my patients in two weeks and determine with them if additional volume would be of benefit I feel it’s better to add later than to overfill and have to dissolve in fact most of my patients are people who come to me for years as opposed to the transaction driven medical retailers my patients and I have long-term relationships

I essentially become their primary care doctor for beauty and I help them understand if the latest injectable or device that they’ve heard about is potentially a value for them the popularity of lip fillers can create a false equivalency between the highest level physician and the injector with a social media account the take-home lesson is to be mindful of the commercial goals of companies selling fillers as well as the commercial goals of low quality medical retailers successful people throughout the world never pay more than they have to for anything when it comes to accomplishing something that they want in value successful people seek out experts whose time and attention ensures them having a greater chance to have successful outcomes

A highly qualified and experienced doctor can help you look your best while minimizing the risk of serious complications complications can occur in anyone’s hands but filler complications require quick and competent management by an expert

If you are on a plane you would want the most highly skilled and experienced pilot since a split-second judgment in a potentially disastrous event can have a tremendous impact on you and the people who care about you

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

[Music]

My right eye seems to be a lot smaller than my left and is noticeable in the pictures. What are my options?
Thank you for your question. You submitted your question with a close-up view of your eyes. And you ask in your question about your perception that your right eye appears to be considerably smaller than your left. And that you notice it in particular when you take photos and you’re asking what are your options. Well, I can certainly share with you what my impression is in the absence of a full physical examination but I think I can give you some guidance as to how I approach this type of situation in my practice. A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with their eyelids especially when it comes to more advanced eyelid procedures such as Asian eyelid surgery has been a very big part of my practice. And I think that when I look at your photos, I can just give you some basic principles that are applicable that can help guide you as to what is probably the option that will fit best for you. So to begin with, this situation, what I see is in the left eye you have a crease and the fold of skin is actually above the crease. When you look at the right eye, you don’t see a crease. You see a fold overlying the eyelid margin. And this is actually a very common situation. You see, there is a certain anatomic variation that is specific of Asian descent and it has to do with the absence of a crease or a presence of a crease. And it is due to an attachment between the muscle called the levator muscle, the muscle that can also sound like the word “elevator” or look like the word elevator without the letter “e”. It’s the muscle that lifts the eyelid. Well, from the front of that muscle are these fibers that attach to the skin. And when they’re attached very firmly, you get a crease. When they’re not attached, you don’t have a crease and the skin folds over. When the skin folds over, it creates the perception of the eye being smaller. And essentially what it is, is that the fold is defining the shape of the eye and so generally speaking, a relatively straightforward issue. What the key is to try to create that connection between the skin and the muscle, the levator muscle and that is the entire basis of Asian eyelid surgery. Now when you learn more about Asian eyelid surgery, you learn that there are non-incisional procedures and incisional procedures. A non-incisional procedure is basically defined by essentially making small openings in the skin and attaching the skin to the muscle underlying the levator muscle and creating that fold. I would say that it is more than likely that in your situation that you would probably benefit from that procedure again, in the absence of a physical exam and seeing how much overlap of skin there is. But when I make this decision, I basically look between the choice of doing a non-incisional and incisional procedure. In an incisional procedure, I’m either removing some skin or addressing a certain amount of fat in order to create that crease and fold. And so in a situation like yours, where all I see is a little bit of folding over the skin, I can actually visualize the placement of the sutures that would result in a crease that would create some balance. Now of course there are pluses and minuses to every surgery and risks etc, but I think that when you get down to why your eye is looking smaller, the right eye than the left, it is because of the fold of the skin. It is very straightforward. In fact in our practice, what I routinely do is use something like a Q-tip just to create a crease and push the skin in a way that mimics what would happen if I were to attach the skin to the muscle with the surgery. And basically, you can then see what it would look like. Like I said, the procedure itself is fairly straightforward. In our practice, we do this procedure under local anesthesia with LITE™ sedation. Especially if it’s a non-incisional procedure, it’s actually fairly straightforward. It’s done pretty quickly. It’s done with local anesthesia. It’s just a matter of allowing the time for the skin to heal over the course of several weeks. But most people go back to work in about a week. And as far as swelling, with Asian eyelid surgery, the area between the crease and the eyelid margin, is an area that can linger for several months but does progressively get better. And it is usually a little bit less swelling in my experience with non-incisional compared to incisional. So I think it’s probably the next appropriate step for you is to meet with qualified, experienced eyelid surgeons who have a lot of experience with Asian eyelid surgery and learn about what your options are based on this particular issue of the absence of a fold resulting in overlapping skin. And of course a proper examination would reveal any other issues that would potentially be useful to address at the time. But again, as I said, my impression is this is basically a matter of getting that skin to fold in so that it matches as closely as possible with the other eye. So I hope that was helpful, I wish you the best of luck and thank you for your question.