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Should I have surgery for under eye wrinkles? Under eye wrinkles
are a common problem, and often the first thing people recognize
as a sign of aging. Since your eyes are so important in communication,
a less than optimal appearance of your eyes can have a negative
effect on how you are perceived. I often see in consultation
patients who pull on their lower eyelid skin which show a
smoothing of these wrinkles. They believe that they have extra
skin which should be surgically removed. Unfortunately, many surgeons
also believe this is the case, so they do remove a significant
amount of lower eyelid skin. This often results in undesirable
changes in the shape of the lower eyelids as well as complications,
which can affect eye health. I’ll discuss how I address under eye
wrinkles in my practice and the steps I take to minimize the
risk of complications. I’m Dr Amiya Prasad. I’m a Board Certified
Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
Reconstructive Surgeon. I’ve been in practice in Manhattan and
Long Island for over 20 years. A wide range cosmetic eyelid
procedures are at the core of my practice. As a
Cosmetic Oculoplastic surgeon, I also revise and restore
eyelid surgery complications from procedures originally performed by other doctors.
As stated earlier, approaching wrinkled skin in the lower
eyelids as a problem of excess is often a setup for complications
of eyelid position and consequently eye appearance and health.
The fact is that lower eyelid wrinkles is associated with changes
in skin quality, not excess skin quantity. Strategies to improve
under eye wrinkles are based on ways to improve the backbone of
the skin, the dermis and the superficial texture of the skin which
is the epidermis. It’s important to remember that eyelid skin is
about .5 mm in thickness and is the thinnest skin in the body.
For skin quality improvement at the dermal level I often use
platelet-rich plasma, or PRP to improve eyelid skin thickness
and health. PRP is a concentration of wound healing and growth
factors present in your own blood. We obtain it by drawing a
patient’s blood like what’s routinely done for blood tests,
then spin it to concentrate a clear, yellowish serum, which
is PRP. The PRP can be placed by injection as well by a skin
boosting device. The effect is to stimulate collagen, improve blood supply,
and thicken the skin, which all helps to improve wrinkles. When it comes
to laser treatment which is generally indicated for people with lighter
skin type, the strategy is to address both the epidermis and the dermis.
For example we perform a procedure with a long pulse Erbium laser
called “smooth eye”. The treatment uses laser to address the dermis
with removal of the epidermis. His avoids the need to take time off
while the skin heals. This procedure is done over several sessions
4-6 weeks apart. We often address under eye wrinkles at the same
time when I perform lower eyelid surgery for under eye bags. I often
use the fractional CO2 laser and apply PRP topically immediately
afterwards. For people with darker skin, I use a radiofrequency
technology such as Pelleve’ instead of laser. As is the case with
many cosmetic skin procedures, non-surgical under eye wrinkle treatment
requires ongoing care to keep the skin looking as good as possible.
This includes the use of topical creams such as in the retinol
family of products. In addition periodic treatment with PRP and
skin boosting can be beneficial. There is the occasional patient
who comes in with folds of skin which they’ve had their own life.
In this type of situation, I surgically remove the skin with a method
called the skin pinch. In my experience, under eye wrinkles can best
be treated non-surgically. It’s important to remember that the expectation
should be to improve the appearance of the wrinkles under the eyes and
not to eliminate them altogether. When it comes to determining which
approach would be best for you I recommend you find a doctor with
extensive experience with multiple modalities and you feel comfortable with.
This is important because optimal skin care requires a long-term strategy
I hope you found this information helpful…thank you for your question.

[Music] [Music] Are the results of eye bag surgery permanent?
Under eye bags which are present all the time is caused by fat pockets located under the eyes
pushing forward like a hernia this puffy appearance is often seen
running in families as a genetic trait bags under the eyes are also associated
with aging sinus problems and allergies during the course of a consultation for
under eye bags patients will often ask me is the surgery for eye bags that they’re
planning to have going to be permanent I’ll discuss how I
address concerns about the longevity of results
you can expect after having surgery for under eye bags
I’m Dr Amiya Prasad I’m a board-certified cosmetic surgeon and
fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in New York City
and Long Island for over 25 years I specialize in cosmetic eyelid surgery
as well as revision eyelid surgery for complications referred
by other doctors one of the most popular procedures i perform for under
eye bags is called transconjunctival blepharoplasty
in conventional plastic surgery under eye bags are approached by the surgeon
making an incision through the skin this approach is called a transcutaneous
blepharoplasty in this conventional approach an incision is made
just below the eyelashes so the skin and underlying muscle can be
elevated in order to gain access to the fat pockets in my practice
my preference is to access the under eye fat pockets
through a transconjunctival approach this means that I’m able to treat the
fat pockets responsible for your under eye bags
from the inside of the eyelids thereby leaving
the outside skin and supporting muscles intact and undisturbed
this technique is considered technically advanced and can be
challenging for a surgeon in comparison to a transcutaneous approach i prefer
the transconjunctival approach because it allows me to preserve the
shape and character of your eyes much more predictably
than with a transcutaneous approach I see a lot of patients for
complications from transcutaneous blepharoplasty these complications include problems
such as lower eyelid retraction and ectropion a common complaint I hear

from patients who have undergone transcutaneous blepharoplasty
from the outside is that they feel that they’ve lost the
shape that was characteristic of their eyes they complained that their eyes ended up
looking rounded and that they don’t look like themselves
in addition I often see patients complaining of having dry
eyes after this approach dry eyes can be caused by excess eye
exposure or from a too low position of the lower
eyelid after surgery this limits the tear film distribution
many of my colleagues justify performing transcutaneous blepharoplasty
because they want to do something about under eye
wrinkles by removing the skin in order to make the skin appear to be
tighter I respectfully disagree with this assertion on the basis that
under eye wrinkles are caused by a loss in skin
quality related typically to aging as well as other contributing factors such
as excess sun exposure smoking and environmental stressors to the skin
although it may look like there is extra skin
under the eyes for most people there’s actually no
excess skin essentially we’re not dealing with a skin
quantity problem but rather a skin quality problem this means that when a
transcutaneous blepharoplasty is performed you can end up with a skin shortage
resulting in problems such as as I mentioned before eyelid
retraction and ectropion since the main issue with the under eye
skin is skin quality we can improve the skin quality with
issues such as wrinkles and skin discolorations through
procedures such as fractional co2 laser resurfacing
the objective in using fractional co2 laser is to refresh the epidermis
and to strengthen the dermis the dermis is the foundation of your skin
and precise heat application to the dermis stimulates new collagen production
thereby improving the appearance of wrinkles I further enhance
skin healing and collagen production with prp
or platelet-rich plasma prp or platelet-rich plasma is a concentration
of the part of your blood responsible for wound healing
two key aspects of wound healing is the creation of
new blood vessels and the production of new collagen both of which are needed
for healthy looking skin as mentioned earlier i sculpt the prolapsed fat
responsible for under eye bags by performing transconjunctival
blepharoplasty generally speaking after i perform
transconjunctival blepharoplasty your eyes retain their natural shape
since the skin muscle and other support structures
are not violated and are left intact some of the art in performing
transconjunctival blepharoplasty is dynamically judging the effect
of fat sculpting on your appearance as I’m performing the surgery
my target is to create the appearance as if you never had under eye bags
oftentimes people with under eye bags also have deficiencies in their
cheekbone structure additionally in your 40s and
older there is a diminishing in bone volume
as well as loss of soft tissue skin thickness and
fat volume this is why i often combine surgery with the placement of
long lasting cheekbone filler at the bone level
using a technique called structural volumizing
the fat pockets responsible for under eye bags
exist in specific anatomic compartments when fat is sculpted from these
compartments it’s unlikely that new fat will occupy
these same compartments in the future however since there is
still fat located further behind the fat that was
sculpted as aging and bone volume loss progresses
there is the possibility that additional fat
may shift forward later in life this means that the longevity of results
is going to be different for someone who’s having their procedure in their
20s in comparison to someone who’s having it in their 60s speaking
from experience it’s not unusual for patients to
enjoy the results of their lower eyelid surgery
for 10 to 20 years and even longer as stated earlier other aging changes
can be addressed with volume enhancement laser and other
surgical options in my practice i perform transconjunctival lower eyelid
blepharoplasty using local anesthesia with light iv
or intravenous sedation my patients appreciate the advantages of this
approach in comparison to the risks and recovery
associated with general anesthesia usually i have my patients returned to
work in about a week with minimal evidence of bruising or
swelling if you’re considering surgery for under eye bags
you can be optimistic about the long-term benefits of this procedure
since the human body is not permanent future aging changes around the eyes and
cheeks can be addressed as needed i hope you found this information
helpful thank you for your question
[Music] [Music]

What are the different treatments for hooded eyelids? Hooded eyes can be caused
by redundant eyelid skin drooping brows or combination of both I’ll address how
I treat hooded eyes every day in my practice with non-surgical and surgical
options
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 I can attest to the value of training in ophthalmology or eye surgery
followed by specialized training of the areas around the eyes proper diagnosis
of the different anatomic causes of hooded eyes as it relates to the eyes is
very important additionally understanding the potential impact on
eye health from any procedure performed around the eyes is critical throughout
my career there have been remarkable innovations with neurotoxins fillers and
surgical procedures I routinely incorporate these advances to create
customized strategies for my patients it is very important to properly analyze
the causes of upper eyelid hooding the appearance of excess skin partially
covering the eyes can often mask the presence of other conditions which cause
the eyelids to droop such as eyelid ptosis eyelid ptosis is a condition
where the margin of the eyelid is lower than it would normally be for that
individual eyelid ptosis is generally caused by
she’s affecting the muscle responsible for lifting the eyelids called the
levator muscle not recognizing the presence of ptosis can result in
disappointment in the outcome of procedures where only the skin is
addressed the Browse play an important role when it comes to managing hooded
eyes an observation I’ve made over the course of my career is how impactful the
appearance of the brows have on facial expression if you draw a cartoon and you
want to show happiness anger or surprise you can do that easily withdrawing the
brows in different ways to show those emotions many times patients tell me how
they are afraid of looking always surprised after a brow procedure because
of people they’ve seen who they say had too much Botox or too much surgery I
look at brow enhancement as an opportunity to artistically shape the
brows rather than just lift them in many situations eyelid hooding can be
improved by addressing the brows with the procedure called a Botox brow lift
this is done by using Botox or a similar neurotoxin such as Dysport or XEOMIN the
neurotoxin works by relaxing the depressor muscles in the brow area that
push the brows down by relaxing the depressor muscles which include the
corrugator Pro Cirrus and orbicularis oculi muscles the muscle which raises
the brows called the frontalis muscle works unopposed thereby allowing lifting
of the brows as is the case with any neurotoxin treatment the result can last
three to six months and the procedure needs to be then repeated another
non-surgical approach to brow lifting and shaping to improve hooded eyes is a
technique where injectable fillers are placed to restore volume which is lost caused
by bone loss as well as loss of fat and soft tissue i often place the filler in
the temples and in the strategic areas of the outer aspects of the brows which
through volume correction helped to create a better looking brow shape when
brows descend to a point where neurotoxin and fillers are not going to
be enough surgical options are then considered although I perform all types
of brow lifting surgery including coronal endoscopic and trichophytic brow
lifts I have found myself being more inclined to performing more conservative
skin-based procedures for artistic shaping as opposed to what I was more
inclined to do in the past which was geared more towards lifting
the coronal brow lift has fallen out of favor amongst most cosmetic surgeons but
can still be used in certain patients the procedure is done with a single long
incision made from behind the hairline for the purpose of excising excess skin
and addressed specific muscles another brow lifting technique is the endoscopic
brow lift this involves small incisions made behind the hairline a camera called
an endoscope is used to see the areas to be operated on from these small
incisions an example of a brow lift which is done only at the skin level is
the trichophytic brow lift this procedure is performed from behind
and within the hairline an advantage of this technique is that it allows hair to
grow through the incision for better camouflaging variations of this method
can be employed for brow shaping which can be performed from naturally existing
forehead lines and even directly at the border of the eyebrow hairs when there
is upper eyelid hooding there is often excess soft-tissue in these situations cosmetic
upper eyelid surgery also known as upper eyelid blepharoplasty is the most direct
procedure to addressing eyelid hooding this is a surgical procedure where
redundant eyelid skin known as dramatically sis is carefully measured
excised and sutured to define the upper eyelids my goal is not to remove as much
skin as possible but rather to reveal the true shape of the eyes the artistry
needed in performing upper eyelid blepharoplasty to appear natural for the
individual whether they’re male, female younger, middle-aged, or older and
factoring ethnic specific characteristics cannot be overstated
both surgical brow shaping and upper eyelid blepharoplasty is performed under
local anesthesia with light sedation avoiding issues related to general
anesthesia patients undergoing either or both surgical brow shaping and upper
eyelid blepharoplasty typically return to work in one week with minimal
bruising and swelling approaching the management of upper eyelid hooding
depends on proper evaluation the extent of the hooding the possibility of
coexisting eyelid ptosis and concurrent issues within the eyebrows in my
practice I help my patients make informed decisions based on the specific
factors which contribute to the appearance of their hooded eyes being
satisfied with the outcomes of any procedure or procedures is more likely
when you understand the diagnosis the treatment strategy and what you should
expect afterwards I hope you found this information helpful thank you for your
question

What can I do about forehead wrinkles? Forehead wrinkles are a common problem
often associated with aging but even younger people can have them due to
repeated facial expressions which cause creases to form in the forehead
other factors include genetics and environmental exposures such as sun
exposure and smoking discussing treatment options for forehead wrinkles
is something I do in my practice every single day
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 the treatment of
facial aging and premature aging changes related to genetics and environmental
influences are a core part of my practice a well-known treatment for
forehead lines is the use of a neurotoxin such as Botox Dysport or
XEOMIN as an oculoplastic surgeon I was amongst the first group of doctors
administering Botox for patients before it was used for cosmetic purposes this
is going back to 1993 I’m also known for my work with other injectable treatments
like cosmetic fillers which can also be used to improve the contour of the
forehead I was also amongst the first group of
cosmetic surgeons to adopt regenerative medicine technology like platelet-rich
plasma or PRP for aesthetic purposes which I also find useful for this area
in addition I have extensive experience with brow lifting surgery which can also
have an impact on the appearance of forehead lines patients come in
complaining about their forehead wrinkles because of the visibility of
the lines on a large area of the face making
you feel that you may have an older looking appearance there are two factors
which contribute to the development of forehead lines one is the continual
creasing of the forehead skin due to facial expression and movement and the
other is the progressive loss of collagen and elastin in the forehead
skin while both causes are seen with facial aging environmental factors like
sun exposure and smoking can lead to accelerated breakdown of collagen and
elastin fibers in the forehead skin which leads to these wrinkles frequent
raising of the eyebrows causing the farhad to repeatedly crease can also
make lines on the forehead become visible prematurely one important
condition which is often results in forehead lines forming is the presence
of eyelid ptosis eyelid ptosis means the upper eyelid position is low because of
a dysfunction of the muscle which lifts the upper eyelid called the levator
muscle unconsciously people with ptosis are constantly raising their eyebrows to
try to lift their drooping upper eyelids in order to see better this also occurs
with eyebrow ptosis and excess upper eyelid skin or dermatochalasis there
are several treatments to address decreased collagen and elastin in the
forehead skin laser radiofrequency or micro needling can have a smoothing and
tightening effect on the forehead skin through the stimulation of collagen
production as a response to the treatment the principle is that the body
naturally produces collagen as an injury response so these medical devices create
controlled injuries to stimulate a collagen healing response there is also
ways to induce collagen production with virtually no
injury we perform a lot of procedures using platelet-rich plasma or PRP PRP is
the concentration of wound healing and growth factors present in your blood
which are activated for example when you have a cut PRP is basically a
concentrated form of your body’s natural wound healing factors which stimulates
collagen production as part of the healing process
the concentrated wound healing and growth factors within the PRP improves
overall skin quality health and thickness I often combine PRP treatment
for forehead lines with the hyaluronic acid filler using a device and method
called skin boosting placing hyaluronic acid into the dermis increases the
volume within the dermis to help lines wrinkles and folds appear less deep PRP
combined with hyaluronic acid has an also a synergistic effect increasing the
effects and benefits of collagen production to treat and reduce forehead
wrinkles due to muscle movement I use an injectable neurotoxin like Botox Dysport
or XEOMIN strategic placement of a neurotoxin into a muscle called the
frontalis muscle which is responsible for lifting the eyebrows reduces the
activity that causes the deep lines to form if you think of the forehead skin
as paper the more is crumpled with activity and movement the more it
creases by reducing the movement there is less creasing with consistent
application of Botox the reduced movement improves the appearance of the
forehead lines even at rest it is important to have Botox done by an
experienced doctor who understands what would look right for you it’s common to
see overdone Botox in the forehead resulting in a frozen unnatural and
expressionless look in my opinion with just the right amount of both
cocks placed in the right way you can improve the appearance of the forehead
lines but still allow for head movement which comes from natural facial
expressions Botox can also be used for non-surgical brow lifting known as the
Botox brow lift to relieve frown lines or the number 11 lines Botox is placed
in the eyebrow depressor muscles which are the corrugator procerus and
orbicularis oculi muscles by relaxing these depressor muscles and by
strategically relaxing part of the elevator muscle called the frontalis a
lift can be achieved while still reducing the appearance of forehead
lines surgical brow lifting is also an option to remove redundant skin and
raise the forehead skin to help with these lines there are several brow
lifting techniques which can be customized to the individuals needs
the surgeons experience and thorough planning prior to surgery are keys to
developing a predictable outcome most swelling and bruising from surgical brow
lifting lasts about one to two weeks and the healing process like any other
surgical procedure continues for a year while there are several options to treat
forehead lines for most patients it can be done without surgery and with minimal
if any recovery time however with time it’s important to maintain results by
periodically relaxing the muscles building on skin quality improvement and
sustaining volume to minimize the depth of the forehead lines I hope you found
this information helpful thank you for your question

Can eye bags be treated by dissolving the fat? Puffy eye bags is one of the most
common facial issues affecting a wide range of people regardless of gender age
or ethnicity this appearance is caused by fat which is normally around the eyes
herniating or pushing forward resulting in having bags under the eyes
these under eye bags are not significantly affected by sleep or diet
it’s routine for me to hear from patients about how frustrating it is to
have eye bags which make the people they interact with think that they’re tired
or lacking sleep in addition what’s often mentioned is that people they meet
think that they’re actually older than they really are

again eye bags that are always visible are likely caused by fat normally around
the eyes pushing or herniating forward creating bulges under the eyes medically
speaking these eye bags are referred to as lower eyelid fat prolapse generally
under-eye bags are a genetic trait so even younger people can have eye bags
with the recent growing popularity of fat reduction options some people
inquire about having the eye bags removed with an injection to melt the
fat I’ll discuss the differences between the fat around the eyes in comparison to
other areas of the body and how I approach helping my patients in the way
I feel is safest for them 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 specialist I perform a wide range of procedures to enhance
the eye area including non-surgical procedures such
as lasers and fillers I routinely perform I back surgery as well as upper
eyelid surgery for hooded eyes double eyelid surgery for Asian eyes ptosis
correction surgery and revision eyelid surgery for complications referred by
other doctors when I see a patient in consultation for under-eye bags I look
at the situation from an anatomic perspective and consider both surgical
and non-surgical options as mentioned earlier lower eyelid fat prolapse makes
the under eye bags bulge forward this creates a hill next to a valley
relationship where the valley is an area of relative hollow
called the tear trough another key an atomic variable is the projection of the
bones which define the cheek including the area directly below the tear trough

I also look at the balance and shape and projection of the cheek bone in
relationship to the under eye area I frequently help my patients camouflage
puffy under eyes by placement of hyaluronic acid filler into the tear
trough I look at the relative shape and projection of the cheek and cheekbone
area when there is a deficiency in these areas I also place thicker hyaluronic
acid filler at the bone level to create a natural harmony between the under eye
and cheek areas

I perform this enhancement by a method called
Structural Volumizing using blunt cannulas and applying the principles
derived from performing facial implant surgery to create natural results
typically without bruising or extensive swelling eyebags can also be more
definitively treated with a procedure called lower eyelid blepharoplasty I
often see patients who first used fillers to camouflage the under-eye bags
and the adjacent hollow tear troughs until there came a point where the fat
pockets became too prominent to camouflage making blepharoplasty the
appropriate next step when it comes to any cosmetic surgery I always advocate
procedures which in my hands are safe predictable and have low risk for
complications with minimal recovery time so does the injection of a fat reducing
chemical into the same space occupied by the eye meet these standards in my
opinion at this time the answer is no a chemical which exists in the bile for
the digestion of fat has been marketed for fat reduction under the chin doctors
are taking the same chemical called deoxycholic acid and using it for fat
reduction in other areas of the body here’s the problem the injection of
deoxycholic acid under the skin causes significant inflammation and swelling to
varying degrees it’s common to see the injected area become red inflamed and
swollen for several days after the injection although this inconvenience is
not usually dangerous to the skin the same cannot be said if this level of
inflammation were to occur in the tissue space around the eyes unlike the skin
the fat around the eyes is part of a deeper complex structure intimately
connected with the eye inflammation could result in scarring double vision
and even vision loss I’m actually concerned that the growing proliferation
of cosmetic services provided by non-surgical physicians as well as non
physicians who were never trained in surgery
will lead to experimentation with injection of deoxycholic acid on their
patients to help them avoid surgery so why do some people try to avoid surgery
and waste their time money and even contend with swelling and bruising when
they get injections done other practitioners just to avoid
surgery worse why would someone even risk their vision by trying a fat
dissolving injection the objection is that people who want to avoid surgery in
my experience comes down to cost the fear of surgical complications the fear
of visible scarring the fear of anesthesia related complications seeing
people particularly in the media whose eyes they feel look unnatural and last
the limited time they may be away from responsibilities such as work and family
well from the time when I was in training I looked at cosmetic procedures
with the same perspective more than 20 years ago I advocated for cosmetic
procedures which were affordable without compromising safety minimizing risk of
complications avoiding incisions which can then eliminate the visible scarring
issue I also advocated for local anesthesia as opposed to the more
standard general anesthesia which significantly reduces the risks of
anesthesia related complications as far as an unnatural appearance is concerned
I personally feel pain whenever I see someone in the media or in person who
has a typically operated and stereotypical plastic look as someone
who is artistic and creative I’m very aware of seeing disharmony which I think
we all are intrinsically sensitive to patients will often mention someone they
know or see in the media and say they just don’t look right this speaks to the
synergy between the surgeon and the patient about what kind of results both
are expecting many times both the surgeon and the patient share the same
vision for a body dysmorphic and exaggerated look this applies also to
procedures such as filler and Botox when it comes to time
away from responsibilities I developed processes in preparation surgery and
aftercare which allow my patient to minimize their downtime in my practice I
routinely address under eye bags that are too prominent to camouflage with
fillers by performing a procedure called transconjunctival blepharoplasty this
means that I performed a surgery from the inside of the eyelids thereby
avoiding any incision on the outside I often combine this procedure with other
procedures to improve the skin quality such as PRP or platelet-rich plasma and
fractional co2 laser I also routinely perform filler placement at the same
time such as structural volumizing for cheeks chin and jaw angle which
complements the eyes and makes for a balanced and youthful face I perform
these procedures in my private operating facilities within my offices in
Manhattan and Long Island under local anesthesia with LITE IV or intravenous
sedation I perform this procedure with the focus on preserving the natural
shape of the eyes such that the eyes appear as if they would have never had
bags prior I have found this maintains the intrinsic character of the patient’s
eyes I’m often told that when their friends and family see them they know
that the patient looks better but they can’t put their finger on why that is
natural my patients walk out after surgery comfortable smiling and thanking
my staff and looking ready for work in about a week when it comes to any
procedure close to the eyes protecting your vision and health of
your eyes is always the highest priority at this time the risk associated with
the inflammation caused by the fat dissolving chemical deoxycholic acid
makes the eye bags an area which I would not treat with this chemical when it
comes to addressing under-eye bags I’ve been able to successfully provide my
patients with a surgical solution which in my hands has resulted in natural and
a refreshed appearance with minimal risk and a quick recovery I hope you found
this information helpful thank you for your question

Can I have eyelid surgery if I have dry eyes?
Many people who suffer from dry eyes can potentially benefit eyelid surgery to treat under eye
bags, hooded upper eyelids, or eyelid ptosis.
At the same time if you have dry eyes, you may be hesitant about surgery because of potential
surgery related causes which may make dry eyes worse . In this video, I will explain
how I approach patients with dry eyes in my practice, and how eyelid surgery can be done
for many patients with dry eyes.
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.
To be an oculoplastic surgeon, you have to first be trained in ophthalmology (B roll
Dr P using a slit lamp).
As an oculoplastic surgeon, I have expertise with disorders of the lacrimal system, which
includes the lacrimal gland, which produces tears and the tear duct system, which drain
the tears.
This background informs all cosmetic surgery I perform in the eye area.
It is often the case where a general plastic surgeon performs eyelid surgery, and then
sends the patient to an ophthalmologist once the patient complains of dry eye symptoms.
The plastic surgeon essentially puts the burden of the surgical outcome onto the ophthalmologist
is now put in a difficult position of having to manage the patient’s dry eyes for years
long after the plastic surgeon compromised the eyelid function.
A systematic approach to identifying the degree of dry eye prior to surgery is very important.
Further, I would add that specific aspects of eyelid anatomy directly affects eyelid
function and will impact future dry eye management.
For example, lower eyelid surgery for eye bag removal is a very popular procedure.
The lower eyelid is very important for proper distribution of tears over the eyes.
You can think this interaction of the action of the upper and lower eyelids to be working
like a windshield wiper to evenly distribute tears over the surface of the eyes.
If there is any change in the anatomy of the lower eyelid, particularly the position of
the eyelid margin, this tear distribution function will be impacted
For example, a very commonly performed technique for lower eyelid surgery is the transcutaneous
method, where an incision is made below the eyelashes to remove and sculpt the fat which
cause eye bags.
It’s common practice to also remove skin at the same time in an attempt to improve
fine lines and wrinkles under the eyes.
Without managing the critical structural support of the lower eyelid, this technique often
compromises the position of the lower eyelid as well as its function.
The result is a pulled down appearance referred to as lower eyelid retraction, which can cause
an inability to fully close the eyes resulting in eye exposure and dryness.
Tear film distribution is also compromised.
For primary lower eyelid surgery for under eye bags, I evaluate the anatomy and function
of the lower eyelid using what’s called a pull test and a snap back test.
These tests help me decide if any additional support procedures would be appropriate such
as a lateral tarsal strip to position the lower eyelid for optimal tear distribution.
My preferred approach to addressing lower eyelid fat pockets is called a transconjunctival
lower eyelid blepharoplasty.
This means I address the fat pockets from inside of the eyelid.
This technique better preserves lower eyelid support structures in particular the support
muscle called the orbicularis oculi and maintain the position of the eyelid margin.
This means the tear distribution is properly maintained.
I routinely perform this surgery on patients with dry eyes, even those with a history of
severe dry eyes.
Additionally, my patients appreciate that there is no visible external scar and the
natural shape of the eyes are maintained.
Oftentimes people who have dry eyes will actually have improvement in their dry eye symptoms
after eyelid surgery.
This is because procedures which improve the tone and position of the lower eyelid combined
with the relief of weight from extra skin on the upper eyelid help the eyelids protect
and lubricate the eyes.
Eyes that look good function well.
When it comes to upper eyelid blepharoplasty, it’s critically important to not remove
too much skin, particularly in patients with dry eyes.
I would also add that with upper eyelid surgery, particular care must be taken to protect a
gland, which produces tears called the lacrimal gland.
The lacrimal gland exists in the same space where the fat pockets in the upper eyelid
are present.
When the upper eyelids appear full and heavy, both the fat and the lacrimal gland can be
responsible for this appearance.
It’s routine to sculpt and remove some fat to create more space.
Unfortunately, it’s been well known that the lacrimal gland has been mistakenly removed
by general plastic surgeons which resulted in significant loss of tear production.
As an oculoplastic surgeon, during evaluation as well as during surgery I look for the lacrimal
gland which is often prolapsed or displaced downward.
Instead of removing the lacrimal gland, I perform a procedure called lacrimal gland
resuspension to restore the anatomical position of the lacrimal gland as well as preserve
the function of the lacrimal gland.
It’s important to have a clear strategy for dry eye management before and after surgery.
It’s well established that there may be some short term decrease in tear production
after eyelid surgery so generally, I advise my dry eye patients to increase the frequency
of lubricating eye drop use prior to surgery.
Further, I work with my patients to help them with dry eye management after surgery.
As far as the anesthesia experience, I perform all my eyelid surgeries with local anesthesia
with LITE sedation.
My patients recover comfortably and quickly so they typically are able to return to work
in about 1 week.
Cosmetic eyelid surgery can be done safely for people with dry eyes.
As mentioned earlier, there are often opportunities to help improve dry eye symptoms with specific
procedures, which are well known to oculoplastic surgeons.
I would state without reservation that a cosmetic eyelid surgery specialist with training in
ophthalmology is ideally suited to perform cosmetic surgery for people with dry syndrome.
I hope you found this information helpful…thank you for your question

Should I get tear trough implants, fat grafting, or filler?
Hollowness under the eyes is a common problem that can even appear in young people.
People suffering from under eye hollowing often seek a permanent solution in the form
of implants, or fat grafting.
I’ll discuss how I counsel my patients about the options for under eye hollowing in my
practice.
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.
For patients who’ve come to me for under eye hollowing, I have performed procedures
such as the placement of tear trough implants, as well as fat grafting.
I’m also well known for my work with cosmetic fillers throughout the face, including the
under eye area to treat hollowing and slight eye bags.
It’s a common request from patients is to have a permanent solution for many things
including under eye hollowness.
Earlier in my career, long before the introduction of injectable fillers, I would place implants
called tear trough implants.
Tear trough implants are made of soft silicone, and are specifically designed for the under
eye area.
When I perform tear trough implant surgery, I insert them through a transconjunctival
approach, meaning from the inside of the eyelids without any external or visible incision.
We understand very well how facial aging is proportionately greater at the bone level,
which means bone loss will progress regardless of the presence of an implant.
This means that with normal aging, the implant may become more visible and additional volume
would be needed.
Another so-called “permanent” option, which is offered is fat grafting.
Simply stated, fat does not provide uniform and predictable improvement and is likely
to not survive or worse become lumpy and irregular.
Patients come to us from around the world distressed about the results of fat grafting
under the eyes with the desire to have them removed.
Technically, the procedures for removal and grafted fat under the eyes is complex and
often requires multiple sessions..
Some doctors offer permanent or semi-permanent fillers.
In my opinion, if given a choice, I would prefer to use a filler that can be easily
removed.
If any of these semi-permanent and permanent fillers were to be seeded with bacteria resulting
in biofilm or frank infection, management can be very difficult.
Once again, placing something permanent in the soft tissue can be cosmetically problematic
as aging and volume loss naturally progresses.
Like fat grafting, removing permanent or semi-permanent fillers is an extremely complicated process,
and not all the material will be removed.
At this time, my preferred treatment for under eye hollowing is with a soft hyaluronic acid
filler such as Restylane or Juvederm.
I place these fillers in my office exam room with minimal trauma using blunt cannulas.
This approach allows me to improve under eye hollows with precision and usually without
bruising.
Soft tissue fillers move well with facial expressions, and they have no rigid edges
which are more often associated with implants.
Hyaluronic acid that makes up fillers like Restylane and Juvederm occurs naturally in
the body, so these types of filler are well tolerated and safely metabolized by the body.
I find that a filler is more customizable than an implant.
Fat graft which can lose 30-70% of their mass during the healing process cannot be customized
in the way fillers can.
Further, I appreciate the security of being able to dissolve a hyaluronic acid filler
within minutes of placement of an enzyme called hyaluronidase.
Just as the face changes with aging as well as other factors such as weight gain and weight
loss, filler placement can be customized to these changes.
Hollow eyes are often associated with crepey and sun damaged skin.
I often use PRP or platelet rich plasma to improve the quality of the delicate under
eye skin.
PRP or platelet rich plasma is a concentration of the wound healing factors in your blood
which stimulates collagen and blood supply to the skin.
There is also a medically well established synergy between hyaluronic acid and PRP.
Placement of filler for the tear trough is quick, however I explain to my patients that
it takes about 2 weeks for the material to settle.
At the 2 week point, I look at the results and compare to the appearance before the procedure
and make adjustments as is appropriate.
When considering under eye hollowing treatment, it’s important to understand there are no
permanent treatments as the body itself is not permanent.
In particular, the bone and soft tissue.
The eye area is delicate, and eyelid skin is the thinnest skin in the body.
In comparing the options of tear trough implant, fat grafting and hyaluronic acid filler, my
preferred approach is the use of hyaluronic acid filler.
My ability to accurately contour with minimal trauma, with convenience as well as ease of
removal makes hyaluronic acid filler the best choice for my patients for tear trough and
hollow under eyes. Thank you for question

What is healing like after eyelid ptosis surgery? Eyelid ptosis is a condition
where the upper eyelid is in a lower position than it should be
ptosis when not associated with the neurologic condition is usually caused
by a dysfunction of a muscle called the levator muscle the word levator is like
the word elevator without the letter e in the beginning there are two types of
eyelid ptosis in this category the first is congenital ptosis which is ptosis
you’re born with the other is acquired ptosis which is ptosis that occurs after
you’re born in our practice we see patients with ptosis every day and
during the evaluation I’m always asked about the healing process the healing
process is very important for the outcome as well as the ability for the
patient to go back to work or be seen during social events I’ll discuss how I
evaluate my patients and provide guidance about the healing process with
different types of ptosis surgery which I perform

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
eyelid ptosis surgery is a specialty procedure which is not typically
performed by general plastic or cosmetic surgeons but rather mostly by
oculoplastic or oculofacial plastic surgeons in fact the presence of ptosis
is often missed when cosmetic upper eyelid surgery is routinely performed
for excess skin and fat in these situations the patients are distressed
because they don’t look better after undergoing surgery since their ptosis
was not diagnosed or addressed the strategy for ptosis surgery is
dependent on the diagnosis of the type of ptosis the severity of the ptosis and
the relative strength or function of the levator muscle to optimize both recovery
and to maximize accuracy I usually perform ptosis surgery with local
anesthesia and LITE IV sedation using local anesthesia instead of general
anesthesia makes recovery from surgery much faster patients who have put under
general anesthesia often feel nausea and dizziness after surgery in addition with
general anesthesia you’re recovering from the effects of
general anesthesia as well as from the surgery itself with local anesthesia and
LITE IV sedation our patients recover from anesthesia immediately and they
feel fine the aftercare process is important for optimizing recovery after
surgery unless otherwise instructed I have patients apply cold compresses to
minimize swelling for the first 48 hours after surgery antibiotic ointment is
applied to the sutures where appropriate a common form of ptosis we treat is
acquired ptosis related to age the use of contact lenses eye rubbing and
allergies generally speaking this type of ptosis is mild with good levator
muscle function in this situation I often perform ptosis surgery by
shortening a muscle from the underside of the upper eyelid if there isn’t extra
skin to remove in the front of the eyelid there’s no visible sign of you
having undergone surgery the recovery from this type of ptosis surgery is
generally the quickest for example I performed this procedure for a doctor
who went back to work in two days I do advise my patients to take a few days
off to allow for the healing process and dissolving of internal sutures I often
use this technique for people who have had cosmetic eyelid surgery done
elsewhere learn after examination that they also
happen to have ptosis by performing the surgery from the inside of the eyelid
these patients feel better about having the surgery performed without having any
new incisions and sutures on the outside ptosis surgery for situations where the
eyelid level is blocking the pupil or center of the eye with good levator
muscle function is often approached by performing surgery directly on the
levator muscle at the same time I often perform cosmetic blepharoplasty to
address excess skin and fat to get the best cosmetic result as well
this approach is often used for age-related acquired ptosis as well as
in cases of congenital ptosis the recovery is comparable to upper eyelid
blepharoplasty where sutures are removed in about one week
and some swelling is present and it diminishes over the next few weeks two
months in some situations such as an asian eyelid surgery and congenital
ptosis the swelling can remain for longer periods and even lasts longer
than six months a less common situation is when the levator muscle has poor to
no function with the eyelid level blocking the pupil in these situations I
perform a procedure called if frontalis sling this is a surgery where a
connection is made between the eyelid and the muscle which lifts the eyebrows
called the frontalis muscle I place a materials such as silicone gore-tex or a
PTFE as well as the patient’s own or cadaver sourced tissue from the leg
called fascia lata generally recovery is about one week with some degree of
swelling which clears over the next few weeks ptosis surgery occasionally
requires revision for situations where the eyelid level may be too low or too
high when enhancement is appropriate I usually wait about three to six months
after the initial surgery to allow for the clear
of swelling the longevity of the benefits of surgery depends on the type
of surgery performed as well as the age and other factors which are individually
relevant if you’re considering ptosis surgery or you’re concerned about one or
both of your upper eyelids being lower than you feel they should be a proper
diagnosis is the first step this first step can involve seeing a neurologist
ophthalmologist or an oculoplastic surgery for the types of ptosis
discussed the healing process and functional recovery can range from days
to weeks with some exceptions I hope you found this information helpful thank you
for your question

what type of doctor is best for filler treatment? Injectable filler placement
for a wide range of cosmetic issues is very popular it has resulted in a wide
range of practitioners offering these types of procedures question which is
often heard is who do I go to for the best results of filler treatment

I’ll discuss the principles of safety and after treatment management which I
believe are important to understand when you’re looking for the right doctor to
perform your injectable filler treatment

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’m well known for cosmetic surgery such as upper eyelid
surgery under eye bags surgery eyebrow lifts face lifts and other surgeries to
treat the effects of facial aging I’m also known for my work with cosmetic
filler placement for the eyes and face related to the genetic and aging issues
wherever there is volume deficiency a common belief is that results are
dependent on the brand of the filler although the choice of filler is
important it’s the doctors technique that is critical to a desirable result
boils down to experience expertise knowledge and the aesthetic style of the
practitioner safety is the highest priority injectable fillers have become
so popular that most people don’t view them as invasive particularly in
contrast to surgery once you enter the skin the procedure is
invasive with this principle in mind I treat placement of injectable fillers
with the same level of care as I do with surgery as with surgery you begin first
with the plan you should have a clear understanding about what you should
expect after the procedure in terms of results and longevity there are common
issues after filler placement such as swelling and lumpiness which are
generally resolved with conservative therapy since these are common and more
severe complications are less common both patients and practitioners can be
inattentive to the risks of more serious complications these complications
include different types of infections such as biofilm a biofilm typically
occurs when bacteria from the skin surface is carried past the skin and the
bacteria attaches to the surface of the filler material since the filler
material does not have a blood supply infection can occur which can be very
difficult to treat another potential complication is when the filler material
is injected into a vessel specifically an artery this can result in severe loss
of large areas of skin and soft tissue and even blindness just like our
approach to surgery where we perform every procedure prepared for an
emergency it’s important to have the necessary
equipment training supplies and it always be prepared for any filler
related emergency as a surgeon I’m available to my patients 24 hours a day
including my patients who I perform injectable fillers for when it comes to
filler placement I believe that the knowledge derived from surgical exposure
is unparalleled since you cannot see through the skin
the placement of filler is dependent on how the different levels of tissue feel

I often see patients who are dissatisfied with filler placement
around the eyes consistently the practitioner who performed this
procedure is not someone who is a surgeon who operates in the eye area the
eye area is a very small and very delicate area a surgeon like myself who
specializes in eyelid surgery and performs filler placement in this area
routinely is less likely to have issues no doctor is above having complications
or dissatisfied patients but I would argue that higher level of expertise and
experience is always to a person’s advantage

I’ve also observed that the
scope of a doctors specialty very often biases the doctors recommendations for
example in the case of under eye bags slight eye bags can be blended and
camouflaged effectively with filler however if eye bags are too prominent then
filler can actually make the eye bags look worse in such cases I would
recommend to the patient to have surgery instead of filler even if the patient
states that they are not interested in surgery I’d rather not treat the person
than treat them incorrectly I’ve seen many non surgeons use fillers
resulting in a way to make the under eye bags look significantly worse I see
patients in this type of situation and dissolve the fillers to reveal the true
underlying Anatomy filler placement under the eyes is often associated with
bruising because of the eyelid area being very vascular as a cosmetic eyelid
surgery I apply my knowledge and experience to place fillers with minimal
trauma using blunt cannula this approach results in less recovery
time and more immediate results the same principle applies to treating hollowness
in the upper eyelids as an oculofacial plastic surgeon I place fillers in a way
which creates a natural and stable appearance with avoidance of common
problems such as the filler getting lost in the eye socket a frequently requested
facial filler treatment is to restore volume or to enhance the cheeks most
doctors place filler in the soft tissue space which is just below the skin
placing cheek filler in this area may look good at first but the filler will
shift making this added volume in your face look soft and doughy instead of
being defined the skin can’t hold too much filler material before it weighs
down the cheeks contributing to a rounded or pillowy unnatural appearance
as a facial cosmetic surgeon who performs procedures like facelifts and
facial implants I know the anatomy of the face in the cheeks this knowledge
and experience has aided my ability to place filler at a deeper level of the
face between the bone structure and the overlying muscle this is called
structural volumizing placing filler at this structural level gives a more
defined natural-looking contour to create a more youthful appearance
nothing inspires more concern about an unnatural look than the subject of lip
fillers I have this discussion every day with patients who are considering lip
enhancement it always begins with the phrase I don’t want duck lips or I don’t
want lips like place the celebrity name there although this discussion is
light-hearted complications from lip filler placement can be quite serious
lip injections have resulted in vascular compromise and resultant tissue loss as
a surgeon before the introduction of modern hyaluronic acid fillers I book
augmented the lips with fat that’s mass tissue during the facelift surgery and
alloderm the principles applied to these procedures are also applied when I place
filler for volume enhancement with blunt cannulas lip enhancement involves
several areas which can be enhanced to create natural and attractive looking
lips the ease of finding a practitioner for cosmetic filler placement makes it
seem like an easy non-surgical procedure without risk filler placement is not to
be taken lightly and it should be seen as invasive as surgery proper analysis
planning adherence to standards for sterility and preparation for
complications are critically important this means the practitioner you choose
should be held to the same high standard you would apply if you were to undergo
surgery I hope you found this information helpful thank you for your
question

Can a facelift be performed with local anesthesia? Facelift surgery is
considered one of the more complex and extensive cosmetic surgery procedures
this surgery involves working below the face and neck skin and manipulating
delicate tissue in order to lift and improve the appearance of the cheeks
gels and neck as a reflection of common practice by general plastic surgeons is
typically assumed that facelift surgery can be performed using general
anesthesia only the thought of being paralyzed temporarily and being placed
on a mechanical respirator can be the primary reason a lot of people avoid
surgery and keep spending time and money on ineffective skin heating procedures

I’ll discuss how I perform all forms of facelift surgery in my practice under
local anesthesia with Lite IV sedation thus avoiding general anesthesia
altogether for my patients this approach allows them to enjoy their natural
results with quicker and more comfortable recovery

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 early as during my training in facial cosmetic surgery I was formulating
concepts and methods to perform facelifts with local anesthesia instead
of general anesthesia I performed the full range of facelift techniques from
mini facelifts to deep plane face and neck lifts using local anesthesia with LITE
IV or intravenous sedation so why is general anesthesia something to be
avoided whenever possible well during general anesthesia
you are completely unconscious and paralyzed requiring a mechanical
respirator to keep you alive general anesthesia requires both intravenous
drugs and drugs delivered through gases which you breathe in due to the type of
drugs used in the effect of general anesthesia on your brain and body
patients can experience nausea vomiting and even memory loss it’s common
practice for patients after general anesthesia to stay overnight at a
hospital or surgery center with close monitoring by nurses these patients
often have extensive facial bandages as well as drains which also need constant
attention patients who have surgery done with general anesthesia in my experience
take a longer time to recover from surgery as they are also recovering from
the effects of the anesthesia many times these patients require pain medications
in the opioid family of drugs in light of the recent rise in problems related
to opioid drug use not to mention the associated side-effects of nausea and
constipation I believe in doing everything I can to minimize discomfort
so opioid level medications are not necessary in contrast to general
anesthesia there are many advantages to performing facelifts with local
anesthesia and light sedation with local anesthesia and IV sedation my patients
breathe on their own without any need for mechanical assistance through after
surgery I also prefer the ease of movement I have to work on the face and
finely-tuned what I’m doing without a breathing tube or other devices
distorting the patient’s face it’s important that results look as good as
possible in the operating room so you look good after surgery by using local
anesthesia with LITE IV sedation my facelift patients are more comfortable
both during and after surgery IV sedation using drugs like propofol
combined with local anesthesia allows me to avoid the use of opioids like
fentanyl my patients sleep comfortably and are
easily awakened after completion of their procedure I place a light facial
bandage with no drains after surgery facelift patients are typically in
recovery for one to two hours after surgery before walking out on their own
and being escorted home I feel that this is preferable to recovering from general
anesthesia and needing to stay overnight at a hospital or other facility I have
found a faster rate of recovery as a major advantage of using local
anesthesia with IV sedation over general anesthesia our patients routinely return
to work in a week to two weeks with limited swelling and minimal bruising
while the use of local anesthesia with Lite IV sedation has made facelift
recovery faster and more comfortable for my patients there are other facelift
procedure methods I’ve also developed to optimize the camouflaging of incisions I
use advanced wound healing technology such as extracellular matrix and PRP or
platelet-rich plasma which has a remarkable effect on the healing of the
skin helping make the incisions look less conspicuous many of our patients
will also have other rejuvenating procedures at the same time as a
facelift such as upper and lower eyelid surgery chin implant and injectable
fillers all of our surgeries are performed in our own certified operating
facilities within our office our patients are comfortable and also
assured of the safety and quality standards which are in line with
hospitals and surgery centers throughout my career I’ve been an advocate of
having cosmetic surgeries such as eyelid surgery and face lift surgery performed
with local anesthesia and light sedation the medical literature is beginning to
acknowledge this thus validating my conviction of standing up for patient
safety and comfort of course in addition to safe and optimal anesthesia practices
it’s important that you and your perspectives
surgeon have a clear understanding of the aesthetic outcome you can expect after
your facelift surgery I hope you found this information helpful thank you for
your question