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How long do facelift results last?
Facelift surgery is often perceived as the pinnacle of treating changes caused by facial
aging.
The surgery does require investment in time and resources so it’s natural for someone
considering a facelift to inquire about how long the benefits of the surgery should last.
I’ll discuss how I counsel my patients as to the longevity of facelift surgery for their
individual situations.
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’ve been performing facelifts throughout my career, and have brought my own innovations
into the procedure such as performing facelift surgery under local anesthesia with LITE sedation
instead of general anesthesia, modifying different types of facelift incisions, and applying
advanced healing materials for better incision healing.
These have all helped make post-surgery recovery easier and faster for my patients, without
compromising the quality or longevity of results. Oftentimes people assume facelifts as being
permanent.
However, no cosmetic procedure is truly permanent since no procedure stops the aging process.
I stress how the objective of a facelift from my personal aesthetic is to help patients
look more like younger versions of themselves.
This means I strive to maintain their individual, unique facial character.
Generally speaking, I’d estimate the benefits of a facelift can last 5-10 years.
There are individual factors affecting the perception of longevity for each patient,
in particular the age at which the facelift was performed.
The timing of when in a person’s life a facelift is recommended in my practice has
changed as other aesthetic procedures have been introduced.
For example, to compensate for bone and soft tissue volume loss associated with aging in
the mid thirties and later, I use long lasting injectable fillers, which I place at the bone
level using a technique called structural volumizing.
The results from structural volumizing can actually appear comparable to a surgical facelift.
Generally a facelift is recommended for significant changes in the skin, muscle, and soft tissue
which results in laxity and downward descent.
This tends to happen from age 50 and older.
There are some cases where a younger person may have a limited facelift due to genetic
factors which cause earlier tissue laxity.–> As is often the situation with cosmetic eyelid
surgery, the age when surgery is performed is important in predicting the longevity of
benefits.
For example, a person who has upper eyelid surgery done when they are in their 30s will
have results which will change with age differently than a person who has the same surgery done
in their 60s.
It’s important to understand that aging changes are not just limited to the skin.
The most significant changes are actually deeper which is at the bone level as well
as the soft tissue just below the skin.–> As I mentioned earlier, facelift results can
be expected to last in the 5 to 10 year range.
My aesthetic for all my cosmetic surgeries as well as non-surgical procedures such as
facial fillers and Botox, is for my patients to retain their facial characteristics that
are unique to them while helping them look younger and refreshed.
Some facelift surgeons believe in a more exaggerated aesthetic, and they have patients who actually
want that look.–> It’s common for patients inquiring about
facelift surgery to be aware that there something called “tightening the muscle” for a facelift
to be performed optimally.
This means that any facelift operation involves some manipulation of a very important support
structure called the SMAS, or the superficial musculoaponeurotic system.
You can think of it as the foundation that helps reinforce and support the position of
the skin that is being moved upwards.
There is a lot of finesse to facelift surgery.
The objective is to optimize aesthetic repositioning with resultant improvement in the neck angle
and jawline while minimizing the visibility of the incisions and preventing any distortion
of the earlobe.–> I routinely perform my facelift procedures
under local anesthesia with LITE IV sedation, so patients can recover more quickly than
they would if the surgery was performed under general anesthesia.
By doing this, our patients are able to leave our operating suite, which is located in our
office in about 1-2 hours after surgery with a small facial bandage, to go home and recover.
This is in contrast to general anesthesia where its routine for you to have to stay
overnight in a facility with facial drains and a nurse to monitor you.
My facelift patients will generally experience limited swelling and some mild bruising.
They usually return to work and their normal routine in about a week to 2 weeks.
Technique combined with the application of stem cell based wound healing technology such
as extracellular matrix and PRP contributes to this quicker recovery.
As with any surgery, the healing process continues for about 1 year.–>
Regardless of facelift technique, the skin and underlying tissue does relax over the
course of 1 year since facial movement and tissue elasticity creates a certain level
of softening of the initial higher level of tissue tone right after surgery.
I educate my patients to expect this before surgery and to remember that young faces aren’t
tight or pulled faces.
A younger face has a youthful appearance based on facial balance and skin quality.–>
It’s important to recognize that once the soft tissue and skin is repositioned after
facelift, there is additional opportunity afterwards to further improve your appearance
by addressing volume loss.
As we get older, facial volume from bone, muscle, fat, and soft tissue diminishes, Many
times, I actually combine volume enhancement with facelift surgery through the placement
of implants and cosmetic fillers.–> For the purpose of restoring facial volume
related to bone loss, I perform a specific technique called Structural Volumizing.
This is an approach where long lasting cosmetic fillers such as Juvederm Ultra Plus are placed
much deeper than with traditional techniques.
This means that the fillers are placed at the same level as facial implants which is
just above the bone structure, and under the muscle layer.
I’m able to create more defined facial volume and structure.
Traditional placement of facial fillers is in the soft tissue layer just beneath the
skin.
The filler in this space can shift, and can make you look doughy and pillowy.
In contrast, I perform Structural Volumizing to create a stable and defined contour.
I often see people who’ve had their facelift performed elsewhere and question why the don’t
look as good as they had hoped.
For these patients, I routinely place filler at the cheeks, chin, and jawline.
Now their facelift results looks much better because there is improvement in the underlying
facial structure.
This approach has been a relief for many people who had facelift surgery and thought they’d
need to have another facelift surgery.
Instead, in less than 30 minutes in an exam room, they look significantly better with
Structural Volumizing.
While the benefits of a facelift can be present for a long time, it’s important to remember
that a facelift does not address bone volume loss or stop the aging process.
It’s important to have a proper evaluation to look at the different aspects of facial
aging.
In my practice, the long term strategy after facelift surgery integrates volume correction
and other nonsurgical procedures to help my patients look their best.
I hope you found this information helpful…thank you for your question

What can I expect from under-eye filler treatment? Every day in my practice I use
fillers under the eyes to address hollowness to camouflage eye bags and to
even improve the appearance of wrinkles under-eye filler treatment can be
performed very quickly and results can often be appreciated right after the
procedure is performed there are different ways to perform these
procedures in this delicate region I routinely see patients who come in
having had filler placement performed by another practitioner resulting in severe
swelling lumps and irregularities as well as dissatisfaction with their
results I’ll explain how I approach injectable fillers under the eyes from
the perspective of a cosmetic eyelid surgery specialist

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years I perform cosmetic
eyelid surgery everyday for conditions such as hooded upper eyelids and under
eye bags I also perform specialized eyelid surgeries such as Asian double
eyelid surgery eyelid ptosis correction and eyelid retraction repair I also
specialize in revision surgery for complications occurring after eyelid
surgery refer to me by other doctors I routinely perform non-surgical
injectable treatments every day for the under eye area for the crow’s feet lines
for upper eyelids and for lips I’m also well known for performing a technique of
Structural Volumizing derived from principles used in facial implant
surgery to naturally enhance areas such as the chin
cheekbones and jaw angle with thicker and longer lasting hyaluronic acid
fillers a common question about under-eye filler treatment is if there
are permanent options available since fillers such as hyaluronic acid fillers
are metabolized I explained that prior to the introduction of hyaluronic acid
fillers I performed a placement of silicone tear trough implants
although implants are permanent facial aging continues which means bone volume
progressively diminishes as does the thickness and skin and the fat around
the eyes as well as the cheeks further in my experience patients appreciate the
convenience safety reversibility of hyaluronic acid fillers which are placed
in my exam room with minimal downtime this is in contrast to a surgical
procedure with downtime that is more than a week I’m able to use the same
principles for facial implant surgery and create highly accurate enhancement
by placing volume to compensate for natural asymmetries in the face which
just cannot be done with the same level of precision when placing facial
implants so what are the particular aspects of the under eye area which need
to be factored in when planning filler placement
well the under eye area is highly vascular so the risk of bruising needs
to be reduced as much as possible I perform these procedures with
instruments called blunt cannulas which allow me to avoid trauma to the blood
vessels this means that patients usually look good right after the procedure is
completed I approach filler treatment with the same level of care as I do with
surgery while filler treatment is not surgery I do consider it invasive since
the filler is being placed through the skin barrier although it’s rare
injection of filler can go directly into a blood
vessel or artery in this area resulting in vascular occlusion causing blindness
as the number of practitioners performing this procedure grows many of
whom are not trained or experienced at a specialty level comparable to an
oculoplastic surgeon there are more complications being reported while there
are risks to any medical procedure these risks can be minimized by having a
doctor who is highly trained and experienced and fully prepared to
immediately address any complication there is a small risk of infection from
the placement of hyaluronic acid fillers since the needle or cannula can
introduce bacteria from the skin surface and cause an infection known as biofilm
on the surface of the filler material fillers can also become encapsulated
where the body forms a shell around the material these issues can be addressed
by dissolving the filler with the enzyme hyaluronidase hollowness under the eyes
is often accompanied by the presence of dark circles to improve the appearance
of the skin which is contributing to the appearance of dark circles I often use
PRP or platelet-rich plasma PRP is a concentration of wound healing and
growth factors present in your blood which is harvested by drawing your blood
as you would for a routine lab test and concentrating the platelets into a clear
yellow serum combining PRP with hyaluronic acid filler can have a
synergistic effect and make a very nice impact on the tired look of hollow eyes
with dark circles interestingly I have found many people with under-eye bags
come in for filler treatment because they see the hollow areas of the tear
trough and don’t realize that they also have puffiness I use fillers routinely
to camouflage eye bags if they are not too prominent by
blending the transition between the puffiness and the adjacent hollow in the
area of the tear trough if under-eye bags
reach beyond a certain threshold treating them with filler may actually
make the bags appear even more puffy I see patients who had fillers placed
elsewhere in this situation and I use hyaluronidase to dissolve the filler I
then really in two weeks to see a filler is still a viable option or if lower
eyelid blepharoplasty is more appropriate I find it’s important to
educate my patient about the relationship between the under eye
hollows and the cheek areas it’s very common to see a deficiency in the
projection of the cheek area just below the tear trough and the under eye as
well as the cheek bone this means that there is often a great opportunity to
create a more significant improvement by combining under-eye filler with
structural volumizing of the cheek and the cheek bones sometimes my patients
express a concern about the potential for having rounded cheeks which they see
in their social circles or in the media I explained that this appearance occurs
when filler is placed just below the skin which does not create definition I
place volume at the bone level as if I were placing a facial implant with
minimal trauma and typically no bruising this creates a harmonious relationship
between the under eye and cheek area which can be very flattering for the
face as a whole a hollow appearance under the eyes can
have a significant effect on how people look at you
in my practice I approach this area with an understanding of the deeper bone
structure which comes from performing surgery essentially I take an inside-out
perspective help my patients recognize how cheek volume
and skin quality under the eyes can also be improved to help them look better has
been invaluable for my patients who then enjoy the benefits of looking more
energetic and confident it’s important to remember that fillers are invasive
procedures and should be taken as seriously as surgery this mean that it’s
in your best interest to take steps to ensure your safety particularly in case
a complication were to arise safety predictability reversibility and minimal
downtime are the guiding principles which I use to help my patients look
their best I hope you found this information helpful
thank you for your question

[Music][Music]my eyes look worse after under-eye
filler what do I do? Using cosmetic
fillers to treat eye bags and under-eye
hollowing has grown in popularity over
the past several years many people are
unaware that fillers can be placed by
physicians and non-physicians with no
surgical experience the safety of the
fillers and the willingness of the
manufacturers to sell more product along
with local state laws allow fillers to
be used without any standardization or
oversight the problem is that fillers
are not always the treatment of choice
in many situations overlooking the
factors which determine who is a better
candidate for filler placement has led
to many people having too much filler
placed under their eyes this resulted in
the appearance of eye bags lumps and
irregularities or even larger eye bags
than they had before treatment
fortunately hyaluronic acid fillers are
reversible and results can be corrected
and managed 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 my
work with upper and lower eyelid surgery
including surgeries for hooded upper
eyelids lower eye bags double eyelid
surgery and oculoplastic specialty
procedures such as ptosis and lacrimal
gland and system surgeries as an eyelid
specialist I also perform revision work
for eyelid surgeries originally
performed by other doctors and these
patients come to us from all over the
world I’m also known for my work with
facial fillers in areas such as the
cheeks jawline lips chin forehead as
well as both the upper and lower eyelids
I also help patients with reapplication
of fillers they’ve had done elsewhere
this is done by dissolving the original
filler and starting from scratch and in
some patients who have had
semi-permanent fillers actually
surgically removing them before applying
a filler with lower risk cosmetic
fillers are effective for slight cases
of under-eye bags as well as under-eye
Halloween filler is placed in the tear
trough below the eye bags to blend with
the forward projection of the puffy
under eye bag making the bags look less
puffy this works well with eye bags that
are not too prominent as the filler can
create a more consistent contour under
the eyes and camouflage the presence of
the bags however if the eye bags are too
prominent and the filler is added to
blend it too much volume from the filler
can exceed a natural-looking contour of
the under eye area so the under eye area
looks more puffy than before the filler
was placed an experienced eyelid surgeon
who also performs under eye fillers
knows where to draw the line between
using filler to camouflage slight eye
bags and when surgery is needed to
reduce and sculpt the fact that causes
the more prominent ibex unfortunately if
a doctor nurse or other practitioner
cannot perform surgery in cases of
larger eye bags they may insist on using
filler to treat this area themselves
rather than referring their patient to a
surgeon when someone is dissatisfied
with hyaluronic acid fillers done
elsewhere I often use hyaluronidase an
enzyme to dissolve the filler and
determine what is the true underlying
Anatomy once I see the true Anatomy I
make recommendations regarding placement
of filler surgical correction or a
combination of the two
our times when someone had filler placed
under the eyes several years prior and
expected the filler to disappear often
time these patients look swollen and
feel that they don’t quite look like
themselves generally fillers placed in
this area are metabolized over the
course of four to twelve months if
filler is still present after 12 months
this may be due to something called
encapsulation encapsulation is when the
body forms a barrier around the filler
which prevents it from being metabolized
naturally in situations like this the
enzyme hyaluronidase can be placed at
the right tissue levels to dissolve the
filler results from hyaluronidase can
often be seen immediately however some
fluid and swelling may take some time to
diminish many times I’ve seen patients
whose doctors attempted to dissolve
their filler several times without
success this is where surgical
experience with deeper anatomy allows me
to place hyaluronidase more precisely to
reveal the patient’s true anatomy I
usually tell my patients to come back
after a week or two to assess if any
residual filler may be present and if
additional dissolution is needed my
patients routinely go back to work the
same day or the next day so what if
dissolving of the under-eye filler
reveals prominent under eye bags and
surgery is the appropriate solution I’ve
developed a strategy to perform surgery
in a way which provides my patients with
the natural appearance with quicker
recovery and minimal downtime it comes
down to surgical technique medical staff
coordination type of anesthesia and
aftercare in my practice I routinely
perform under eye bags surgery in my
office operating facilities certified by
the Joint Commission with local
anesthesia and light intravenous or IV
sedation I perform a procedure called
conjunctiva blepharoplasty which allows
me to address the fat pockets from the
inside of the eyelids which though
technically more complex is actually
less traumatic and disruptive to the eye
anatomy this preserves the true shape
that most people want to maintain
essentially my patients are able to go
back to work in one week with minimal
swelling or bruising in fact many
patients who come to us to address their
dissatisfaction with fillers have
recounted how they had swelling and
bruising four weeks after filler
placement they are often impressed on
how my performing surgery resulted in
less swelling and bruising than when
they had filler injection many times my
patients who come in for removal of
filler are doing so because they have an
important event coming up whether I
place filler or perform surgery I would
recommend at least two weeks of lead
time to allow for settling and stability
the growing popularity of non-invasive
procedures creates a perception that
these solutions are just as good as
surgery this is of course not true but
these procedures do have a place as a
surgeon I’ve integrated many minimally
invasive procedures in my practice
including injectables micro needling
lasers and radiofrequency technology to
provide my patients with comprehensive
strategies and solutions particularly in
areas where surgery is not enough for a
patient full needs it’s important to
recognize that any procedure where the
skin is being medically altered or a
needle is being placed through the skin
is an invasive procedure I routinely
place fillers for patients who have
minimal fat prolapse with under-eye
Halloween I also will not perform
injectables when surgery is the more
appropriate solution your option if
under-eye filler makes your eyes look
worse
is to first dissolve the filler to
restore your pre filler anatomy once
that is done you can determine what is
appropriate in your situation now
knowing that both injectable placement
and surgery can have comparable risk and
recovery I hope you found this
information helpful thank you for your
question
[Music][Music][Music][Music]

What’s causing my eyelids to look droopy?

Eyes that look droopy can create the impression that you’re tired or lacking energy or always
sleepy.
Droopy eyelids can also affect your vision.
I’ll discuss how I evaluate and help people who come in concerned about droopy eyelids
everyday in my practice.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I perform a range of cosmetic eyelid procedures as well as complex reconstructive and revision
eyelid surgery.
I routinely perform eyelid procedures that are not usually performed by general plastic
or cosmetic surgeons such as eyelid ptosis correction, as well as surgery for complications
after eyelid surgery such as eyelid retraction and ectropion.
A very common cause of a droopy appearance is the presence of heavily hooded eyelids.
Hooded eyelids are seen when the upper eyelid skin becoming redundant with age and sun exposure.
The medical term for redundant eyelid skin is dermatochalasis.
In some situations where the eyelid hooding is mild, I use botulinum toxin to relax the
brow depressor muscles, this is often referred to as a Botox brow lift.
When someone has relative skin redundancy resulting in hooded upper eyelids, I perform
cosmetic upper eyelid surgery, also called upper eyelid blepharoplasty.
This procedure is customized to address redundant skin, soft tissue and fat.
Although upper eyelid surgery is performed by a wide range of doctors, I cannot emphasize
enough how deceptively complex this procedure is.
I often laugh when a colleague uses a phrase like “it’s just a simple bleph”.
It may be simple in their mind when you only perform this procedure in a limited way on
a limited category of people.
In my practice, I have a wide range of patients who I perform blepharoplasty for ranging from
young Asians who want double eyelid surgery to older people who need ptosis surgery and
brow lifting surgery to fully address their droopy appearance.
As a specialist in revision surgery, I can also attest to how much millimeters matter.
A skin shortage after blepharoplasty can cause eye exposure and require skin graft surgery.
When a patient comes in concerned about drooping eyelids, I look for the presence of a condition
called eyelid ptosis.
Ptosis is a descriptive term in medicine to describe something that is drooping.
Eyelid ptosis means that the upper eyelid margin is in a lower position than it should
be.
Ptosis is frequently seen in the presence of excess skin over the eyelids, or “dermatochalasis”.
It’s particularly important to distinguish if the ptosis is caused by the physical weight
of the upper eyelid skin or by the muscle, which lifts the eyelid called the levator
muscle or a combination of the two.
I’ve observed that the presence of ptosis is frequently disregarded by general plastic
surgeons.
These patients often feel that they went through the trouble of having cosmetic eyelid surgery
but they still look very tired.
The most common cause for ptosis in adults is the atrophy, thinning or stretching of
the tendon or aoponeurosis of the muscle, which lifts the eyelid called the levator
muscle.
The word “levator” is spelled like the word elevator, without the letter “e”.
If I suspect a neurologic cause for eyelid ptosis, I refer my patient to a neuro-ophthalmologist
for evaluation.
You can also be born with ptosis, a condition called congenital ptosis.
Again, most commonly, ptosis in adults due to thinning or stretching of the levator muscle
and is referred to as involutional ptosis.
The levator muscle can also be affected by trauma directly as well as from swelling after
trauma.
As stated earlier, physical weight on the eyelid from upper eyelid skin and skin below
the eyebrow can physically weigh the eyelid down causing what is categorized as “mechanical
ptosis”.
I perform a ptosis evaluation to determine the eyelid height and strength of the levator
muscle.
In addition I perform other ophthalmologic measurements and examination to insure you
have proper eye function after surgery.
There are different surgical procedures to address ptosis.
In order to address eyelid ptosis, one of the more frequent procedures I perform is
to shorten a muscle from behind the eyelid called Mueller’s muscle.
This procedure, called conjunctivamuellerectomy is done for mild eyelid ptosis and I often
perform this procedure at the same time when I perform cosmetic blepharoplasty.
In other situations, I perform surgery directly on the levator muscle.
These procedures include levator advancement and levator resection.
Typically this is done when the levator muscle function is good.
For more severe ptosis cases where there is little to no function of the levator muscle
I create a connection to the muscle that lifts the brow called the frontalis muscle, in a
procedure called a frontalis sling.
It is challenging to achieve the optimal height, contour and symmetry in ptosis surgery.
I often have the patient sit up during surgery so I can see how they look with gravity.
I routinely perform eyelid surgery under local anesthesia with LITE IV sedation.
My patients recover much faster than they would under general anesthesia and they typically
go back to work in about 1 week A condition that may appear like the eyelids
are drooping often seen with eyelid ptosis, is hollowing above the upper eyelids.
This appearance can be seen after fat removal when someone has had previous cosmetic upper
eyelid surgery.
This appearance can also be due to fat and bone volume loss due to aging.
I find that enhancing the volume above the upper eyelid can restore the character of
the eyes and improve a drooping appearance.
I prefer to use a hyaluronic acid filler placed precisely with a cannula for this area.
I have performed fat grafting for this area before the hyaluronic acid fillers were an
option.
Fat grafting is less predictable and prone to complications, which are difficult to manage.
I like the predictability, precision, safety and reversibility of hyaluronic acid fillers,
which can be done in my exam room as opposed to in the operating room where fat grafting
is performed.
Closing: The appearance of drooping eyes is a common
issue caused by different conditions.
The art is first understanding what outcome will result in a naturally aesthetic outcome.
A proper evaluation by a specialist to identify the specific anatomic factors, which can be
skillfully addressed is critical for a successful result.
I hope you found this information helpful…thank you for your question

What can I do about my vertical lip lines? The appearance of vertical lip
lines above the lips can make you appear and feel older than you are my patients
will point to these lines and exclaim how much they hate them as with any
solution we begin by understanding the specific anatomic issues before
developing a treatment plan I’ll discuss how I address vertical lip lines and lip
appearance 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 I perform treatments for the lips and area around the lips every day in my
practice it is all too common to chase lines in the aesthetic field this means
to either plump the lines with fillers or resurface the lines with chemical
peels and lasers I take a more global perspective when a patient expresses
concern about vertical lip lines for example I look at the volume of the lips
as well as the projection of the cheeks and chin to see how the overall
aesthetics can be balanced such that the lip lines are not the main focus when
you look in the mirror or are engaged in a social interaction I start every
consultation by taking photos from several angles and I placed these photos
up on a screen so that my patient can see themselves in a more objective way
it’s common for people to lose perspective by focusing on one area and
magnifying that specific issue while not recognizing the car
text in which this issue is part of other significant anatomic features my
analysis always begins from the inside outward the cheek and chin bone
structures play an important role in the way the lips appear I show my patients
have sagging cheeks a receding chin and downward turning of the outer corners of
the mouth are contributing to the overall appearance of the area around
the lips as I always say the whole is great in the sum of its parts
there are some situations where a younger person has some isolated lines
which can be treated without any other areas needing attention
generally speaking awareness of vertical lip lines is a significant concern for
lighter skinned women who are in their 40s and older often there is a family
history which makes this a genetic trait that can be made worse by lifestyle
factors such as smoking and excessive sun exposure at the skin level these
lines are due to a loss of collagen in the dermis or backbone of the skin as
collagen diminishes in the dermis the skin loses strength and support so lines
wrinkles and folds develop in addition as we age we lose volume especially in
the face from diminishing bone muscle skin thickness fat and soft tissue the
lips can lose volume and soft tissue causing once full lips to look deflated
the action of a muscle around the mouth called the orbicularis oris muscle can
also contribute to the formation of vertical lip lines this is the muscle
that is active when you pucker drink through a straw or smoke as in other
areas of the face I look at the lines as static which means present at rest and
dynamic which means deeper with muscle contraction
lines which are deeper and causing static Alliance to develop because of
repeated action I treat with the botulinum toxin such as Botox Dysport
Xeomin and Jeuveau I look at the volume loss below the skin where
vertical lines exist as a natural extension of the volume loss occurring
in the lips if you think about it the lines would not appear as significant if
the lips appear to be more full the art is to enhance the lip volume so the lips
look natural with the rest of the face I find that people are so afraid of
looking overdone that I have to place minimal volume into the lips and then
add more in a few weeks if they want more volume I use softer hyaluronic acid
fillers such as Restylane-L and Juvederm XC for the purpose of lip volume
enhancement and restoration of volume directly below the vertical lines I also
use softer fillers like Restylane Silk and Juvederm Volbella when I treat
individual lines at the level of the dermis when you look only at the skin
quality there are two basic issues one is the loss of collagen in the dermis
and the other is the surface irregularities in the epidermis which is
also a reflection of the contour within the dermis this is where I need to
create a customized treatment plan specific to your skin I have
successfully treated this area with fully ablative and fractional erbium and
CO2 laser the downside of these options is the healing process the epidermis
needs to heal and the skin can be raw and red for weeks afterwards I found
that although people were willing to deal with this recovery in the 90s and
early 2000s tolerance for what is perceived as longer healing periods is
less than it’s ever been I’ve also found that once there is
improvement with fillers there’s often less motivation to pursue more
aggressive treatments I’ve developed treatment strategies to improve the skin
quality which do not require any downtime for example to help improve the
skin quality I use PRP or platelet-rich plasma PRP is the concentration of wound
healing and growth factors present in the blood which are activated when you
have a cut I deliver the PRP with a special device directed towards the
dermis without any bleeding or making the skin raw in addition to PRP I use
hyaluronic acid in the same device to provide a scaffold for the collagen
generated by the PRP to build upon we call this procedure skin boosting and
the patient comes in at regular intervals to build upon the collagen
induced by the previous treatment I often combine skin boosting with a non
ablative laser such as a W-switched laser and a 250 microsecond and Nd:YAG
laser we call laser skin toning I described us as similar strategy to
building muscles with weight training the epidermis can also be improved with
minimal downtime with a lighter fractional laser and long pulsed erbium
laser we also used a water-based microdermabrasion technology called
hydro facial which exfoliates and hydrates the skin without any downtime
in the current marketplace commoditization of products and
procedures has overshadowed the value of a highly trained and experienced doctor
to be on your side since companies sell lasers and injectables the marketing is
focused on the tools and not the practitioner non physicians and
physicians with limited experience in the core aesthetic specialties have
created a false equivalency in qualifications
which consumers are just not aware of every treatment carries risk for example
the lip is a very vascular area and filler can be injected directly into a
blood vessel resulting in a vascular occlusion where blockage of a vessel or
artery can lead to a catastrophic tissue loss so regardless of how many Instagram
followers the injector has the patient who has his event has to be referred
emergently to a physician who was a specialist to deal with the complication
of this injectors treatment in a marketplace where transactions are more
important to the sellers than long-term consequences of any given procedure I
recommend and you be your own advocate and invest your time and resources in an
aesthetic specialty physician who will be there for you for the long term I
hope you found this information helpful thank you for your question

How can I treat wrinkles around my eyes?
Wrinkles under and around the eyes inspire people to spend a lot of money on solutions
from miracle creams to medically based procedures.
The specific reasons for different types of wrinkles determine how the wrinkles are treated.

I’ll discuss the way I help my patients who come in concerned about wrinkles under
and around the eyes.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.

I specialize in cosmetic procedures of the eyes and eyelids, and treating the signs of
facial aging, ranging from advanced techniques such as upper and lower eyelid surgery; injectable
treatments around the eyes such as cosmetic fillers, platelet-rich plasma, and Botox;
as well as laser and radiofrequency treatments for eyelid skin.
Many people first recognize signs of aging around their eyes.

This includes wrinkles just below the eyes, to crow’s feet that appear when smiling
or squinting.
We face people every day with our eyes, and the eyes are the first thing we see in the
mirror.
The appearance of your eyes can project an impression to another person in a fraction
of second that you’re tired (even if you’re not) or older than you really are.
So, it’s natural to want to refresh the appearance of your eyes and diminish the signs
of aging, and tired looking eyes.
There are two basic types of wrinkles around the eyes: static wrinkles which appear when
the face is at rest, or with no expression; and dynamic wrinkles that appear when smiling
or other facial expressions.
Treating these two different types of wrinkles need separate approaches

Wrinkles are one of the most noticeable aspects of an aged appearance.
While there are more significant causes of facial aging such as loss of facial volume
from bone loss and sagging as skin and underlying support gets weak, wrinkles are what most
people see when they look at themselves and conclude that they are aging.
There is a common misconception that under eye wrinkles are caused by excess eyelid skin.
Patients will sit in front of me and pull on their lower eyelid skin and believe there
is excess.

In actuality, this stretchy characteristic is more the result of decrease in skin quality
and facial volume loss.
Nonetheless, well-meaning doctors often try do address under eye wrinkles during lower
eyelid surgery by removing skin.
In my opinion, this is not the best treatment for wrinkles under the eyes, as skin shortage
can make pull the eyelids down, making the eyes look rounded and hollow.
Under eye wrinkles are most commonly caused by collagen loss, not excess skin quantity,
so treatment should be about improving the eyelid skin, rather than removing it.

Lines that appear around the eyes with facial movement expression, such as those commonly
known as crow’s feet, appear due to muscle activity.
Collagen loss and breakdown as well as constant creasing of the skin make these lines appear
prominently, even at rest.
Since movement causes the these lines to deepen, limiting movement can help diminish these lines.

Wrinkles under the eyes are treated by improving lower eyelid skin quality.
This may involve heating devices such as lasers or radiofrequency technology applied with
precision to stimulate the body’s collagen production.
The body produces collagen as a response to injury, so applying heat as well as removing
part of the upper layers of skin as in the case of ablation is a controlled injury.
Increased collagen in the lower eyelid skin makes the skin thicker, and healthier.
In addition, removal of the top layer of skin cells, allows new and fresh layers of skin
cells to emerge.

It is important that heating and ablative devices are not overused as too much heat
energy or overaggressive ablation can cause the skin to become thinner.
Collagen stimulation is not limited to the application of thermal energy and laser devices.

Collagen production and increased blood supply in the lower eyelid skin can be stimulated
with a regenerative treatment called platelet-rich plasma, or PRP.
Platelet-rich plasma is a concentration of the platelet component of the blood, which
is responsible for healing when you have a cut.
PRP is concentration of the wound healing growth factors that can also stimulate a collagen
and also stimulate more blood supply the under eye skin.
PRP can also be used to help help with skin discoloration under the eyes commonly known
as dark circles.
To reduce wrinkles around the eyes that appear with movement, the treatment approach would
be to reduce the movement that cause these wrinkles.

This movement can be reduced by limiting muscle activity with a neurotoxin such as Botox,
Dysport, or Xeomin.
Reduced movement makes the lines appear less deep.
An artistic and experienced touch with injectable neurotoxins is important so that natural movement
and facial expressions are not affected.
With time and regular treatment, lines and depressions in the skin caused by constant
muscle contraction improve.

It is important to understand that wrinkles around the eyes cannot be completely eliminated.
The goal here is to improve or to reduce the wrinkles.
As is often seen on some well known people, attempting to completely erase lines and wrinkles
could result in frozen, expressionless faces that don’t look natural.
When can you go back to work: Laser and radiofrequency may take a day to a week before returning
to work.

The healing process which going on below the surface is characterized continued collagen
production and remodeling.
PRP can be placed below the skin as well as in the upper layers of skin and can have anywhere
from no downtime to a day or two . Neurotoxins like Botox and Dysport take about 3 days for
effect and 2 weeks for full effect.
It is routine for our patients to go back to work right after treatment.
When it comes to lines and wrinkles under and around the eyes, I always discuss aspects
of lifestyle with my patients.
Simply said, anything that’s not good for your health is not good for your skin.
Poor diet, smoking and excess sun exposure of indoor tanning with ultraviolet light accelerated
loss of collagen.

I also discuss strategies for keeping the skin looking good for the long term through
regularly scheduled treatments and skin products such as sunblock and cosmeceutical products.
In the modern world, people are being constantly bombarded by irresponsible messaging from
the internet and television.
Hype for products and procedures result all too often in people having poor outcomes and
permanent skin damage.

A lot of people make the mistake of having procedures based on coupon offers to save
money or from inexperienced practitioners only to spend more money and time trying to
repair their overtreated or damaged skin.
I recommend to find a doctor who you can trust to have your best interest in mind and be
your guide to navigate through all the messaging before you undergo a procedure.
In my practice, I provide my patients with a treatment plan with an understanding of
what to expect with the procedures I’ve recommended.
I hope you found this information helpful…thank you for your question

What are the effects of prp facial treatment?

Platelet-rich plasma is a concentration of wound healing and growth factors found in your own blood, and used naturally by the body for healing for example when you have a cut. Platelet-rich plasma, or PRP stimulates collagen production and improves blood supply. This helps improve skin quality in particular, fine lines and wrinkles; Patients report experiencing a glow to their skin which is often commented on by friends and family. PRP is unique in aesthetic and regenerative medicine as it is completely natural, and comes from within your own body. The effects of PRP have long term benefits however like any other solution in the aesthetic field, it’s important to understand clearly what can be expected from the use of PRP and how it can be part of an overall strategy to help you look your best.

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 am amongst the first cosmetic surgeons who used of PRP for aesthetic procedures more than 10 years ago after its original use in regenerative medicine by oral surgeons and orthopedic surgery. I routinely use PRP for patients to help improve fine lines and wrinkles, and under eye dark circles. I use it in conjunction with procedures such as microneedling and laser skin resurfacing. I use it with hyaluronic acid for a procedure called skin boosting which I use to help people with fine lines, skin discolorations from sun damage and acne scars. I am also a member of the Vampire Facelift Network of doctors who are trained to combines PRP with a hyaluronic acid filler to help treat facial aging. One of the most significant uses of PRP has been my customized use of PRP with ACellular matrix for nonsurgical treatment of male and female pattern hair loss we call TrichoStem Hair Regeneration.

You can think of PRP as a facial treatment that starts from the inside, with visible effects on the outside. PRP improves the fatty layer under the skin, which is essential for a soft, youthful appearance, and for facial volume. Increased collagen and improved circulation gives facial skin a softer look and glow. PRP preparation first involves a blood draw, not unlike what is done for a routine blood test. The PRP is separated from the blood using a centrifuge, and prepared for use.

PRP is commonly mistaken or misrepresented as a filler alternative or a non-surgical facelift method, which is inaccurate. This confusion is to some degree is associated with the Vampire Facelift, which is a very specific procedure using PRP and one syringe of a hyaluronic acid filler injected into strategic areas of the face, as conceptualized and defined by Dr. Charles Runels, the creator. The Vampire Facelift is meant to lift the skin away from the bone structure with a subtle outward effect using PRP, and a little filler for volume, but the procedure does not lift skin, muscle, and underlying soft tissue like a surgical facelift. PRP does not lift the skin, nor does it tighten the skin significantly. It does improve skin texture.

The effect of PRP on facial skin is ongoing after the treatment is performed. For optimal skin improvement, a maintenance schedule for PRP treatment can be done.

Closing: Platelet rich plasma is a remarkable, natural material, which has a wide range of benefits to the skin. The many applications in combination with other aesthetic procedures such as microneedling, skin boosting, laser resurfacing and hyaluronic acid fillers has made PRP invaluable for my patients

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

Can I treat eye bags with cosmetic filler instead of surgery?

Under eye fillers have become a popular and convenient way to help improve the appearance
of under eye bags.
Filler placement under the eyes require no surgery, and can be performed in minutes to
help camouflage under eye bags..
This procedure can be performed with minimal to no bruising.

It’s important to understand that under eye filler cannot be used in all cases of
under eye bags, and that surgery is often the better option.
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.
As a cosmetic eyelid surgery specialist, I perform a wide range eyelid procedures every
day such as eye bag removal, treatment of upper eyelid hooding, Asian double eyelid
surgery, and oculoplastic specialty procedures such as eyelid ptosis correction, orbital
and lacrimal system surgery..

I am also well known for my work with injectable fillers for the face, particularly in the
the eye area, cheeks, chin, jawline, and forehead.
Essentially, unlike physicians who cannot perform surgery, I am not limited or biased
in treating the under eye area with any modality.
Many people with under eye bags are relatively young and often hesitant to consider surgery
preferring to have the under eye area treated with filler.

While eye bags can occur and become more prominent due to age, they are mostly caused by genetics,
and can occur as early as during the teen years, and in some cases even younger.
So, what are eye bags ? Eye bags are caused by fat.

Fat normally surrounds the eyes can push forward, like a hernia.
This is why the fat that causes eye bags is referred to as herniated fat.
Fat herniation under the eyes is called lower eyelid fat prolapse.

During consultation, I look at the prominence of the fat and relationship of the herniated
fat to the surrounding bone structure.
For example, there is an area below the under eye bag referred to as the tear trough.
I look to see if the puffiness can be blended with filler in the tear trough.

Generally, I use soft tissue fillers such as Restylane or Juvederm in this area as long
as the under eye bags aren’t too prominent.
It’s important to understand that fillers improve the appearance of eye bags, not by
reducing projection, but by adding projection to the adjacent area.

In some situations where the bags are too prominent for optimal blending, I perform
this procedure as a short term solution for people who want to look better and will undergo
surgery later on.

If the under eye bag projection is past a certain limit, as in the case of more prominent
or severe eye bags, then adding additional volume may not blend the contour of the eye
bags, and actually add more puffiness to the area, making the eye bags look even more prominent.

When selecting a doctor, keep this in mind that many doctors who are not surgeons will
choose filler to treat all eye bags cases, which means in many situations, the filler
placement can result in bigger eye bags.
When eye bags are past a certain level of projection, fillers are not appropriate and
surgery is the treatment of choice.
This surgery is referred to as lower eyelid blepharoplasty.

There are two techniques, one is called the transcutaneous approach where an incision
is made below the eyelashes, to address the fat bags.
The other approach is referred to as the transconjunctival approach where the fat pockets are addressed
from the inside of the eyelids.

In practice, it is common for many doctors to perform the transcutaneous approach to
also remove eyelid skin in an attempt to reduce wrinkling.
In almost all cases, I strongly advise that lower eyelid skin not be removed as it can
lead to complications such as rounding of the eyes, or eye exposure from skin shortage
known as lower eyelid retraction.
Oftentimes, the inside of eyelid is exposed and irritated is due to skin removal.

This condition is referred to as ectropion.
My preferred method is a more specialized technique called transconjunctival blepharoplasty,
where no external incision is made.
I approach the fat pockets from the inside of the eyelid to sculpt the fat.

Since no external incision is made, the results look natural, as if you never had eye bags.
This method preserves the lower eyelid support structures since no skin is removed, and the
anatomy of the eyelid is not compromised by disruption of the muscular support..

When performing eyelid surgery, I most often sculpt the fat to remove the bulge, but leave
some fat behind to create a smooth contour in the lower eyelids, and prevent the lower
eyelids from looking hollow.
Lower eyelid surgery is an art, so not all surgeries are performed the same way.

Having this procedure done with no external incision allow the results to appear natural,
and preservation of fat to prevent hollowed appearance provides for optimal outcomes when
performed by experienced surgeons.
Injectable fillers placed under the eyes is routinely performed with topical anesthetic
for patient comfort.

In addition, fillers like Restylane are also contain some anesthetic.
I usually prefer instruments such as blunt-tipped cannulas instead of needles to reduce the
risk of bruising after the procedure and minimize swelling caused by repeated needle entry.

Generally there is minimal downtime and I see the patient again two weeks after the
procedure to see how the filler has settled, and if additional enhancement is needed.
In my practice, eye bag surgery through the transconjunctival method is performed with
local anesthesia, with LITE sedation for comfort.

I prefer local anesthesia with sedation for almost all my surgeries as my patients are
more comfortable and able to avoid the recovery from the side effects of general anesthesia.
Consequently, my approach results in easier recovery and fast healing from the surgery.
Surgery in my practice is performed in our own in-office surgical suite, certified by
the Joint-Commission for standards of safety and sterility.

Patients routinely go home after surgery without any difficulty..
As far as downtime, patients can return to work pretty much immediately after under eye
filler.
In fact, many patients do it over their lunch hour, and return to work afterwards.
There is the possibility of of some bruising after the procedure which typically fades
in a few days.

When performed with local anesthesia, lower eyelid surgery patients return to work in
about a week.
Interestingly, we have found that the limited bruising from lower eyelid surgery can be
comparable to the bruising seen with the use of fillers.
Oftentimes, patients have much less bruising after my performing lower eyelid surgery than
patients who’ve had filler procedures done elsewhere.
The techniques I’ve developed over my career combined with the systems for care and recovery
allow my patients to recovery from lower eyelid surgery much faster than traditional surgery.

I discuss with my patients how to look at their options from a perspective of procedure
longevity.
Softer hyaluronic acid fillers like Restylane can last 6 months to 1 year before they are
eventually and safely broken down by the body.
The benefits of lower eyelid surgery can last many years.
Once fat pockets are removed, those fat pockets don’t come back.
While there is a chance that other fat around the eyes can prolapse forward the eyelid appearance
can be stable for many years.

Neither fillers or lower eyelid surgery address skin quality such as crepiness.
Supplementary procedures for eyelid skin rejuvenation treatments like laser resurfacing, wrinkle
treatment, and platelet-rich plasma may be considered to address crepey skin, pigmentation
and wrinkles.
When can you look good for an event: If you want to look good for an event, both filler
and surgery can be performed on relatively short notice.

I look at each individual situation and make recommendations based on my experience.
Filler placement is a convenient option for limited eye bags, with minimal to no recovery.
Lower eyelid surgery is a more definitive procedure that can be performed for any degree
of fat prolapse, with results as if you’ve never had eye bags or surgery.
Patients often choose to have filler placement under the assumption that they don’t have
time for surgery recovery.

In our practice, applying modern, faster healing methods, recovery from eye bag surgery can
comparable to the time it takes for filler results to settle.
Lower eyelid blepharoplasty really brightens up the whole face with minimal surgery.
In fact, many patients who I’ve operated on, comment on the ease of their experience
with their procedure and state that if they had been previously aware of how easy it was,
they would have done it sooner.
I hope you found this information helpful…thank you for your question

What is healing like after eye bag surgery? Puffy eye bags are very common which is why cosmetic
surgery for under eye bags is one of our most popular procedures we perform in our practice
under eye bags are seen in younger to older people regardless of gender and ethnic background
eye bags are essentially fat compartments which have herniated forward causing a
bulging appearance in the lower eyelids cosmetic lower eyelid surgery is the most definitive way

to address these herniated fat pockets for many people who I see this is the first time
they’ve had to consider an elective cosmetic surgical procedure in addition to concerns
about safety people are very concerned about the healing process after surgery I’ll discuss what

I do to help my patients recover as quickly as possible in addition to making their experience
comfortable and convenient I’ll also discuss how i perform the procedures so my patients look
natural as if they never had under eye bags I’m Dr. Amiya Prasad I’m a diplomate
of the American Board of Cosmetic Surgery and a Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in New York City and Long Island for over 25 years

I perform lower eyelid surgery to help people with under eye bags in my practice most often using the
transconjunctival or from behind the lower eyelid approach I perform a lot of revision lower eyelid
surgeries originally performed by other doctors to address complications such as lower eyelid
retraction I also perform cosmetic upper eyelid procedures for hooded eyes as well as specialized
oculoplastic procedures lactose surgery or surgery to lift drooping upper eyelids
an additional example of what I do is surgery for eyelids affected by thyroid eye disease
many people who are aware of puffiness around the eyes they feel they can can be caused by lack of

sleep salt intake allergies and sinus issues this type of puffiness is more fluid related
while puffiness under the eyes that’s constant regardless of sleep and other possible causes
is from prolapsed fat now fillers can be helpful to camouflage minimal fat prolapse I help a
lot of my patients with tear trough filler to improve the appearance of hollowness adjacent
to prolapsed herniated fat it’s interesting that a lot of people perceive hollowness and
don’t recognize the presence of prolapsed fat as a significant factor contributing to the contrast

making the hollowness look even deeper another way to think about it is that there’s a deep
valley next to a mountain or a mountain of fat although camouflage with filler can be
useful the more definitive treatment is to address the prolapsed fat surgically

since the beginning of my practice over 25 years ago I focused on optimizing surgery
to make these procedures more accessible to a wider range of people essentially I focused on
the aspects of surgery that could be improved to reduce risk and to reduce recovery time
for under eye bags I use a specialized approach called transconjunctival blepharoplasty

what I do is I sculpt the fat pockets that cause the eye bags from the inside
of the eyelids and avoid any outside or external incisions or scars the assistants who
work with me are very experienced with these procedures I perform and this means that there’s no time wasted

during surgery and this allows the patient to have a much shorter operative time
our post-operative protocols are administered also very efficiently the type of anesthesia
is another major factor that contributes to recovery I perform all my eyelid surgeries using
local anesthesia with LITE IV sedation my patients avoid the risks and prolonged recovery
typically associated with general anesthesia when I first started my practice using local

anesthesia for eyelid surgery many other surgeons were disparaging me only to later or much later
acknowledge the safety of local anesthesia and the advantages of light sedation
our patients typically return to work about a week after surgery generally there’s little to
no bruising which ironically is far less than the degree of bruising endured by people who
get filler injections performed elsewhere in their effort to avoid having surgery
after healing it appears like you’ve never had eye bags even up close because there is no

external incisions in my experience this approach has many advantages over more traditional external
approaches many people who have lower eyelid surgery from an external approach end up with
rounding of their lower eyelids because of a combination of compromised support structures
of the eyelid and skin shortage from skin removal in an attempt to achieve skin tightening

when this happens the shape of the eyes change and many people feel like they just don’t look like
themselves anymore I actually perform revision surgery to correct these problems from what’s
called a transcutaneous or external blepharoplasty originally performed by other doctors

the approach I employ by performing transconjunctival blepharoplasty I’m
able to preserve the natural anatomy of the eyelid thereby preserving the character unique to your
eyes if there are under eye wrinkles I treat the real issue which is diminished skin quality not
excess skin quantity so instead of removing skin I perform procedures such as fractional CO2 laser

PRP treatment to the lower eyelid skin in my practice recovery after cosmetic
lower eyelid surgery can be minimally disruptive and you can appreciate as early as a few days
not having under eye bags I often say that the results are like you had a facelift where the
whole face looks brighter and more rejuvenated when you don’t have bags under your eyes anymore

in fact many of my patients have expressed that if they had known that the procedure
had been so straightforward an experience they would have had the procedure much sooner
I hope you found this information helpful and thank you for your question

Why did my face look like a pillow after cosmetic fillers? volume loss is one of
the first significant signs of facial aging as we age the appearance of full
and defined becomes more flat or sunken facial volume loss due to aging is
caused by loss of bone muscle fat and soft tissue the application of cosmetic
filler is a popular treatment to augment or restore facial volume but many people
find themselves looking soft and pillowy after this type of procedure

I’ll discuss different aspects of adding facial volume and how that pillowy look
can be avoided

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 in addition to performing all types of surgical
procedures such as facelifts and eye lifts

I perform non-surgical facial
volume enhancement procedures every day in my practice people come in
periodically after a facial filler procedure done elsewhere and they
complain about looking soft like a pillow or looking doughy the volume
augmentation does not look firm and often with some random dimpling in the
cheeks they end up looking bloated rather than defined and youthful so what
causes volume augmentation to result in a pillowy look it’s anatomy specifically
the level and the techniques applied most doctors place cosmetic fillers just
below the surface of the skin or under the dermis fillers are commonly placed
in the fat and soft tissue space underneath the dermis and rely on the
sent an overlying skin to hold them in place this space has limited ability to
maintain the shape of a filler even when precisely placed in the office
it can look good initially but the filler spreads and creates a doughy look
some doctors actually intentionally placed a larger volume of fillers to
balloon the skin to fully fill the potential space in such a way that the
cheeks end up looking large and disproportionate from my perspective
this exaggerated and unnatural appearance makes rational people afraid
to consider cheek volume enhancement in many ways comparable to the fear of
having duck lips like some well-known people in the media many doctors who
perform these procedures are not surgeons with any experience with
working at the level of the bone structure early in my career I worked as
a division chief of oculoplastic surgery at a level one trauma center and
performed surgical reconstruction for facial trauma and tumors routinely in
addition in my cosmetic practice

I’ve routinely performed facial implants
which need to be placed directly on the bone when it comes to facial
rejuvenation what is overlooked by many doctors particularly dermatologists is
where most of the volume loss from aging is actually occurring it’s at the bone
level a few millimeters of bone loss corresponds with a significant loss of
volume yet filler placement is routinely placed just under the skin which
reflects an outside 2.n approach

I approach facial rejuvenation from an
inside to out approach by applying my knowledge and experience as a cosmetic
and reconstructive surgeon I place specific fillers at the bone level with
minimal trauma to create a more structured and youthful appearance
essentially applying the principles used in facial implant surgery to the
placement of resilient and long-lasting acid fillers at the bone level usually
with minimal to no bruising often times I find the results to be superior to
what would have been achieved on that same individual if they were to have
even a facelift the facial fat and soft tissue layers now lay over the
foundational structure volume looking contoured and is natural and soft to the
touch

I routinely let my patients know in consultation that if you’ve had
facial filler done and you’re unhappy with the results as long as the material
is a hyaluronic acid filler such as from the Restylane or Juvederm families of
fillers the results can be reversed with the enzyme hyaluronidase after the
dissolving I can place the facial fillers in a more anatomic and aesthetic
way patients can look pretty good right after this procedure which only takes
minutes for the full face including the chin jawline and cheeks

I normally see my patients about two weeks after the procedure for follow-up if your face
looks like a pillow after undergoing filler placement you still can achieve a
natural look with structural volumizing at the bone level many times patients
blame the filler for their outcome it’s important to see filler as a material
just as clay is to a sculptor it is the sculptor that determines how the
sculpture looks not the clay as I stated earlier

I often start with patients who
have a pillowy look from their previous procedure by first dissolving the filler
and starting over with structural volumizing techniques to achieve a more
structured contoured and natural-looking result I hope you found this information
helpful thank you for your question