Benefits of Platelet-Rich Plasma Facial Treatment

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

Eye Bags How Treatment with Filler or Surgery is Determined

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
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
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

Healing After Eye Bag Surgery

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

Causes of a Pillowy Face after Cosmetic Fillers

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

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

Chin Augmentation Chin Implant or Filler?

Should I get a chin implant or filler?

Chin augmentation can be very successful procedure for people who want more projection for their
It can also result in a more contoured facial profile, achieve a more chiseled look, or
extend or better define the jawline.
Chin augmentation be done with a cosmetic filler, a surgical implant, or a combination
of both.
I’ll discuss how I counsel my patients to help them make the best choice for their situation.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
I’ve been in practice in Manhattan and Long Island for over 20 years.
For many years, facial implants such as chin implants have been a big part of my practice.
More recently, I’ve been using an advanced filler placement technique that reaches the
bone level of the facial structure, which has become a significant, non-surgical chin
augmentation treatment.
When it comes to chin augmentation, my patients will express wanting something that is safe,
long lasting, with immediate results, and minimal to no downtime.
Before choosing a solution, I first make an assessment.
I look at the relationship of chin projection with other parts of the face, such as the
nasal base, and the lips from a side view.
I measure these relationships using the established facial references such as Steiner’s Lines,
Ricketts’ Lines, and the Frankfort plane.
I also use the Golden Ratio, which is a natural proportion of beauty of 1.6 to 1 that we are
intrinsically drawn to as it occurs throughout nature.
When a patient is looking for a long term solution, I discuss chin implant surgery.
Chin implant surgery involves placing a silicone implant on top of the chin bone.
I typically do this procedure from just below and behind the chin, which heals very well
and is typically barely detectable.
This is a fairly straightforward procedure done in our office operating facility using
local anesthesia with LITE IV sedation.
The advantages of chin implants is they are long lasting.
It’s commonly assumed that implants are permanent, however the shape and size of the
face does change with age as bone, muscle and soft tissue of the face gradually diminishes.
Disadvantages of chin implant for the purpose of chin augmentation are the same as any implant
The implant can shift, can become infected or need to be removed if the patient chooses
to do so because of dissatisfaction with the outcome which is additional surgery.
I’ve found that a significant percentage of patients who want chin enhancement are
not comfortable with having an implant.
This is where the modern and longer lasting fillers provide my patients a more attractive
Cosmetic filler placement can be done in an exam room without surgery, and still get the
same results as a chin implant.
I would also add that the control I have in the precise placement of volume allows me
to even get better results.
Technique is critical to successful outcome.
I use a technique to place filler in the chin called Structural Volumizing.
Comparable to placement of an implant, I place the filler on top of the bone structure.
I use thicker and longer lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma.
I perform this procedure using blunt cannulas instead of needles as the technique creates
less trauma to the skin, soft tissue and muscle.
While we can achieve results comparable to chin implant surgery with a the procedure
which is performed in minutes with patients usually returning to work the same day or
the next day.
Initial results can be seen immediately after the procedure and settles over several days.
I usually see patients in follow up after 2 weeks to review their results and compare
before and afters as well as assess if enhancement would be beneficial.
Result from placement of long lasting fillers can range from 1 to 2 years.
Should any issue occur which requires removal of filler, as opposed to surgery, the hyaluronic
acid filler may be dissolved in minutes with the enzyme hyaluronidase.
Hyaluronic acid, the substance that makes up fillers I prefer, including Juvederm Ultra
Plus and Juvederm Voluma, occurs naturally in the body, so these fillers are safely metabolized
by the body with time.
The choice of filler or implants for chin augmentation comes down to understanding your
In my practice, I’ve seen a trend for more than 20 years toward a preference for minimally
invasive and minimal downtime procedures whether the procedure is surgical or nonsurgical.
I find that the acceptance of filler placement over surgical implant to be the basis for
continuous growth in structural volumizing for chin enhancement in my practice.
Thanks to the introduction of thicker, longer lasting fillers with the application of minimally
traumatic techniques for filler placement at the bone level, I find that I’m more
inclined to recommend filler for chin enhancement.
I find that the ability to make microadjustments at different levels from the bone outwards
allows me a type of control that cannot be done with an implant.
Oftentimes, patients also choose to have volume enhancement in other places such as the cheeks
and the lips to create better facial harmony and balance.
I hope you found this information helpful…thank you for your question.

Factors in Combining Upper and Lower Eyelid Surgery

Can I get upper and lower eyelid surgery done at the same time? Cosmetic upper and
lower eyelid surgery or blepharoplasty is a very popular procedure throughout
the world the goal of these procedures is to improve the aesthetics of the eyes
by addressing excess and sagging upper eyelid skin often associated with
genetics and aging as well as the appearance of puffy under eye bags other
issues which can be addressed in the eye area include upper and lower eyelid
hollowing wrinkles and dark circles which may be addressed non-surgically

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 specializing in aesthetic procedures I perform a wide range of
cosmetic eyelid procedures I also treat complications of eyelid surgery
originally performed by other doctors I have throughout my career developed
several techniques in eyelid surgery to allow for minimal incisions save for
anesthesia and quicker recovery it’s important to understand some basic
principles in a younger person the skin quality tissue volume and bone structure
gives the upper eyelids a youthful appearance the supporting structures can
change due to genetics aging and medical issues the upper eyelid area can have
fat pockets prolapse forward hollowing and excess skin referred to as

Under eye bags which are caused by lower eyelid fat prolapse is
often associated with genetics and if many young people under eye bags that
are also often seen with facial aging it’s common to see both sagging skin in
the upper eyelids as well as under eye bags at the same time another issue
affecting the upper eyelids which is commonly associated with aging is upper
eyelid ptosis ptosis means that the upper eyelid position is lower than it
should be and this position is unrelated to the physical weight of the upper
eyelid skin ptosis has to do with the muscle that raises the eyelid called the
levator muscle like the word elevator without the letter e the condition needs
to be identified before any cosmetic procedure so the muscle which lifts the
eyelid is addressed at the time the surgery is performed to get the best
outcome for many people the appearance of excess skin on the upper eyelids
puffiness in the upper eyelids and hooded eyes can be very frustrating many
of our patients note how it’s difficult to apply makeup to the upper eyelids
being perceived as older or lacking in energy is also a common complaint
expressed by patients during consultation in fact the appearance of
looking tired even when well-rested is one of the most common reasons for
inquiring about eyelid procedures these conditions affecting both the upper and
lower eyelids often occur concurrently so wanting to have both upper and lower
eyelids procedures done at the same time as a frequent request there are specific
procedures used to address hooded upper eyelids and puffy under eyes depending
on the underlying causes and the degree of severity
for example the appearance of hooded upper eyelids may be improved non
surgically I’ll be it temporarily with the procedure called Botox
brow lifts if the upper eyelid fullness is caused by eyebrow position
only if the eyebrow position has descended more significantly while
surgical brow lifting options may be considered as well if there is excess or
sagging skin over the eyes the more definitive and long-term solution is an
upper eyelid blepharoplasty an upper eyelid blepharoplasty is a procedure for
restoring the upper eyelids shape and contour creating a more rested and
refreshed appearance excess upper eyelid skin is carefully measured a design is
drawn to address the excess skin and additional tissue below the skin is
artistically contoured so the eyes look refreshed and natural afterwards gentle
handling of this delicate tissue with meticulous care allows for minimal
bruising and swelling after surgery resulting in quicker recovery as far as
under eye bags are concerned there are usually two approaches which are
considered these are the transcutaneous approach or the transconjunctival
approach the transcutaneous approach involves making an incision right below
the eyelashes to get to the fat pockets it typically leaves an external scar and
an approach that can be potentially lead to complications due to compromise of
lower eyelid support structures in addition unnecessary skin removal can
contribute to problems such as lower eyelid ectropion and lower eyelid
retraction for most of my patients regardless of age and ethnicity

I prefer the transconjunctival approach this procedure is considered technically more
complex but in my hands has proven to be safe with minimal risk of complications
patients find this approach particularly advantageous as I’m able to maintain the
natural shape of the eyes and avoid the rounded look which is seen all too
commonly after eyelid surgery preserving the shape of the eyes allows me to
provide my patients with the feeling of confidence about retaining their
character while looking more refreshed specialized procedures for upper eyelid
ptosis or drooping upper eyelids due to a weakened levator muscle can be
performed at the same time when addressing the excess upper eyelid skin
as well as under eye bags specialized surgery like ptosis correction is done
almost exclusively by oculoplastic or oculofacial plastic surgeons like myself
this is not usually done by general plastic surgeons or cosmetic surgeons

I routinely perform upper and lower eyelid surgery with any of the advanced or
additional procedures and necessary all at the same time all procedures are
performed using local anesthesia with light intravenous sedation which means
easier recovery and less downtime in comparison to eyelid surgery performed
under general anesthesia the upper eyelids heal extremely well and the area
where sutures are placed blends very well with the adjacent skin even when
the eyes are closed upper and lower eyelid surgery when performed together
usually takes less than two hours to perform minimal bruising and swelling
are typical after upper or lower eyelid surgery and my patients routinely go
back to work in one week upper and lower eyelid surgery can be performed at the
same time with minimal risk and quick recovery

I recommend meeting with qualified and experienced oculofacial plastic and
reconstructive surgeons who specialize in cosmetic eyelid surgery so you can
learn about your options I hope you found this information helpful thank you
for your question

Getting Fuller Lips that Look Natural

How do I get fuller lips that still look natural?

Lip augmentation for fuller and
attractive lips is a very popular procedure which can be technically
performed in a few minutes when I discuss this procedure with my patients
they often expressed a concern about people they see with bloated and
unnatural looking lips these overdone lips create a negative perception of
cosmetic procedures especially so-called duck lips associated with celebrities
and other people in the media however when lip enhancement is
performed with artistry in experienced hands lip augmentation can be
beautifully proportional and balanced 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 a variety of facial cosmetic procedures such as
eyelid surgery facelift facial fillers facial implants as well as injectables
lasers and other skin treatments I can attest to the value of artistry with
years of experience performing surgical and non-surgical procedures in the face
providing a foundation and an advantage to treating specific areas like the lips
the key is balance when someone looks at you they look at an area within an
inverted triangle which includes the eyes cheeks lips and chin the importance
of lips aesthetically can be appreciated by the high level of interest in
cosmetics such as lipstick and lip liner billions of dollars are spent on
products which are sold to create the perception of full and youthful
lips the limitation is that no cosmetic product can enhance or restore lip
volume and definition before choosing fillers or neurotoxin like Botox or
Dysport for lip enhancement I take photos of your face from different
angles often my patients will show me how their lips looked when they were
younger to give me a sense of whether their lips
were naturally thin in the past or any other specific characteristics they want
to preserve some of our younger patients bring photos to show an ideal lip
appearance that they would like their lips to resemble in addition I review
some important principles which guide my approach to lip aesthetics I begin with
looking at the front view of the lips with some ethnic specific exceptions I
apply the golden ratio also known as Phi which is a ratio underlying Beauty seen
throughout nature the ratio of 1 to 1.6 applies to proportions in the face
including the volume and size of the lips a proportion which also applies to
the lips is one-third to two-thirds which means that the balance is
one-third for the upper lip to two thirds for the lower lip I also look at
the projection of the lips from the side in relation to the chin and other
guidelines using specific measurements refer to Ricketts and Steiner lines I
look in detail at specific aspects of lips such as the philtrum, Cupid’s bow
the vermilion border the lip body the G and K points and the orientation of the
outer corners of the lips I look at the skin quality around the lips such as the
presence of vertical lines and skin discolorations objective measures and
proportions guide the artistry to determine how the lips will fit with the
rest of the facial features I think it’s important to recognize some concepts we
go enhancement of the lips when patients
who are younger come in there are two common situations the first is the
younger person who feels their lips are genetically thin or they feel that the
upper lip is too thin in proportion to the volume of the lower lip the second
situation is when a younger person has proportional volume in their lips and
want to further enhance or beautify their lips for people who are noticing
aging changes in their face such as loss of volume where the lips have become
dinner with loss of definition of the Vermilion border as well as some or many
vertical lines the purpose is to restore or correct the lip volume and definition
I would also note that more men are coming in than in previous years for lip
enhancement regardless of age every patient wants their lips to look natural
and not overdone they are also concerned about how they will look immediately
after any procedure done to enhance the lips in particular the risks of
significant swelling or bruising I discuss a strategy with my patients
based on their specific concerns as well as the techniques I apply to allow them
to have minimal swelling or bruising lip enhancement can include the use of
neurotoxins such as Botox or Dysport for vertical lines outer corner lip lift and
for the upper border the lip to turn slightly upward often referred to as a
lip flip the other part of lip enhancement involves a restoration or
augmentation of volume this is where I use different fillers from the
hyaluronic acid family such as Restylane and Juvederm hyaluronic acid exists
naturally in the body and the filler material is slowly metabolized and
usually lasts about 4 to 6 months I use different fillers to fill fine lines and
volume in the lips there is a lot of artistry in lip filler placement
the challenge is to place the filler with minimal trauma repeated injections
with needles can result in swelling which makes accurate placement more
difficult I routinely use blunt cannulas to minimize needle related trauma to the
lips and patients are often surprised as to how little discomfort they
experienced my approach in comparison to having lip procedures done elsewhere
naturally less swelling and the absence of bruising allows my patients to return
to their regular activities sooner than they would have with more traditional
approaches many people come in last-minute needing to look good in a
few days generally speaking this is achievable
I do routinely see all my injectable patients after two weeks to see how
things have settled and to see if additional filler would be beneficial
there is no question that the appearance of lips is very important to facial
appearance artistically performed lip enhancement can create a remarkable
effect on facial balance and appearance the popularity of lip enhancement
procedures makes choosing the right practitioner challenging understanding
that the ideal experience requires a combination of detailed analysis and
planning with maximal comfort and minimal trauma I hope you found this
information helpful thank you for your question

Causes of Bruising from Lip Fillers and How to Avoid Them

How do you cover bruises from lip filler injections? The desire to have attractive
lips is the reason why cosmetic brands sells so much lipstick lip gloss
and lip liner in my practice I find that a lot of my patients both men and women
who come in for cosmetic eyelid rejuvenation such as enhancement for
hooded eyes or puffy under eye bags as well as for injectables for cheekbone
chin and jaw enhancement appreciate how the lips are also affected by aging when
we discuss lip enhancement with fillers two major concerns come up one the fear
of looking like a duck – the fear of bruising I assure them that the fear of
looking like a duck or the list of people in the media they mentioned whose
lips look too big is something I’m confident that will not happen when I
perform their lip enhancement my goal is to make the lips look appropriate for
the individuals facial features so the lips don’t look out of place as far as
bruising is concerned they often mention a friend or several friends who had
bruises and swelling which was so significant it prevented them from going
to work again I assured them by explaining that as a surgeon who’s
performed a wide range of lip procedures long before the popularity of injectable
fillers I have my own approach to enhance the lips and consistently avoid
bruising 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
bruising occurs when there is bleeding when bruising happens during or after
lip filler injection it’s due to the needle piercing a blood vessel the more
times a needle pokes the lips the more likely a bruise will occur this also
increases the numbers of bruises I begin any lip enhancement with first and
analysis of the aspect of the lips which would benefit from additional volume
this allows me to consider strategically how to use the least number of points of
placement to achieve the desired outcome I routinely use blunt cannulas instead
of needles to place filler by using blunt cannulas there is less of a chance
of piercing a blood vessel in contrast to a needle for lips I use a range of
hyaluronic acid fillers such as Restylane-L, Restylane Silk, Juvederm XC
and Juvederm Voluma I find these softer fillers ideal for the natural soft
quality of the lips this allows for the lips to move naturally with talking
smiling eating and kissing I prefer hyaluronic acid fillers over other
options such as fat grafting or implants I’m able to place these fillers with
fine precision to address volume and contour asymmetries these materials are
metabolized naturally because hyaluronic acid occurs naturally in the body
unfortunately disproportionate lips and bruising strikes fear in the hearts of
men and women considering lip enhancement as with general health
prevention is the best approach although excessive swelling and bruising from lip
augmentation can be common both issues can be addressed with optimal technique
I feel that there is a particular value for a lot of patients who come in and
wear lipstick in a way where they literally draw the lips they wish they
had this means that the lipstick goes well outside of the borders of the lips
essentially there is a potential space where the lip volume has diminished
typically associated with aging that can be enhanced as I often discuss during
consultation lips play a very important part in your facial appearance minimally
traumatic and artistically placed volume can have a tremendous impact on your
appearance don’t let the fear of swelling or bruising stop you from
enjoying the benefits of naturally full lips I hope you found this information
helpful thank you for your question

Minimizing Hair Transplant Scarring and How Hair Transplants can be Avoided

How can I minimize scars from a hair transplant?
Prior to establishing the nonsurgical treatment for thinning hair which we call Trichostem®
Hair Regeneration, minimizing the scars from hair transplant surgery was one of the most
significant challenges I faced when performing hair transplant.
I’ll discuss my perspective on how hair loss is optimally managed including hair transplant
surgery as well as nonsurgical hair loss treatment.
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 performed surgical hair transplant throughout my career with most of my experience being
with FUT which is an abbreviation for “follicular unit transplantation” also known as “strip
The “strip” refers to the strip of hair bearing skin that I would remove to use for
hair grafts.
As a Cosmetic Surgeon who routinely performs facial procedures such as facelift and brow
lift, I focused on how to attain a well-healed minimally perceptible scar.
One of the tools I used in this effort was extracellular matrix by ACell.
This material enhances wound healing through the activation of your own adult stem cells.
I routinely used this material to optimize healing for facelift incisions as well as
for reconstructive procedures.
This strategy worked out very well as I found the strip incisions to heal faster with overall
better long-term results.
I also used the same material to enhance the healing of the hair grafts.
A major frustration with hair transplant surgery is that a percentage of hair grafts will not
survive ranging from 10% to as high as over 90%.
I found that with acellular matrix that the hair grafts healed much better and the survival
rate of the grafts went up considerably.
I also noticed that after one year that thinning hair located outside of the transplanted area
actually increased in number and became thicker.
This was the inspiration for my developing a system of treating thinning hair without
Around the same time, the popularity of strip surgery was being overtaken by a different
approach called FUE or follicular unit extraction.
This was essentially because of the frustration felt by people who had hair transplant surgery
with what was referred to as “ugly strip scars”.
In my opinion the so called “ugly strip scars” was the result of an aggressive single
procedure or multiple strip harvesting creating significant skin shortage and tension resulting
in suboptimal healing.
I would also assert that many people were being operated on who were not good candidates
for hair transplant surgery, which resulted in poor healing of the donor area incision.
In many instances, if the patient had straight or wavy hair, these scars could be hidden.
During this time it became a popular trend, particularly for younger people to wear their
hair very short making the strip scar less desirable.
This resulted in a growing demand for FUE surgery, which was being marketed as “scar-less
The term “scar-less” surgery is inaccurate.
The grafts are harvested in a much larger area than FUT surgery with small round skin
There needs to be a minimal distance between these punches, which results in a wide area
of hair bearing skin to be harvested from.
This area is way outside of the true permanent hair zone.
Further, the claim of scar-less surgery is far from accurate.
In actuality, there’s considerably more scar tissue in comparison to an FUT or strip
The more significant issue is the survival rate of hair grafts.
In FUE surgery, it is generally understood that about 30% of grafts are transected which
means there is no root when the hair graft is placed.
In addition, due to the limited amount of tissue in each graft, the graft survival rate
is lower in comparison to FUT or strip surgery.
I find that when the question of minimizing scarring in hair transplant surgery is raised,
it is predicated on an assumption that hair transplant surgery is the best option for
your hair loss.
This may not be the case.
During the many years I performed hair transplant, I found that most people who come in for consultation
for hair transplant are men and women with thinning hair.
Typically, they would come in when they felt that their hair loss was getting much worse.
Frequently, the perception was that their hair loss was progressing much faster than
it was over the past few years.
The fact is that hair transplant surgery does nothing for hair thinning.
As mentioned earlier, I developed TrichoStem® Hair Regeneration in part because I recognized
that there was a potential to get results which could be better than surgical hair transplant.
How could that be possible?
Since most people coming in for consultation had thinning hair, I recognized that the density
of their existing hair was much better than the density that would be created with a hair
Native hairs exist naturally more close to each other than a hair transplant can safely
The density of your native hair even when thinning can be 50-100 hairs per square centimeter,
while a transplant is typically about 20 grafts per square centimeter.
This means that reactivating hair that is not growing and thickening of your thinning
hair can result in better coverage than hair transplant surgery.
I worked everyday on dosing and delivery methods for optimal results using Acellular matrix
and PRP or platelet rich plasma.
I followed my patients closely with high resolution digital photography and microscopy every three
to six months for years.
It became clear that my hypothesis was right.
Contrary to the assumptions of hair transplant surgeons for whom the first line for hair
thinning is surgery, TrichoStem® Hair Regeneration provided more effective scalp coverage than
even 2 hair transplant surgeries.
In fact, the success of this system of hair loss inspired to me to build a freestanding
center in Northern Virginia, to help make our system accessible to more people.
One variable that is relevant, particularly for people with good density is that during
hair transplant, much of the existing thin hairs are permanently lost because of direct
trauma during surgery as well as vascular compromise and inflammation.
This has always been well known as so called; ”collateral loss” with the rationale being
that the thin native hairs were going to go away eventually and thicker hair were being
When someone has already lost a lot of hair and they are losing their hair at a fast rate,
hair transplant surgery cannot keep up with this degree of loss.
Each surgery after the first typically has less hair to harvest for grafts.
More surgery, means more scars.
I regularly see people who had several hair transplants over the course of 5 to 10 years
and still they don’t appear to have much hair.
Now, with TrichoStem® Hair Regeneration this approach of performing multiple surgeries
to keep up with progressive hair loss is no longer the first line of therapy for thinning
I feel that the only indication for hair transplant is to place hair in an area toward the front
where the skin is smooth and bald for many years.
For everyone else, since 2011, TrichoStem® Hair Regeneration has been the optimal system
for men and women with thinning hair in my practice.
There are of course limitations.
Hair loss is not cured, hair loss is managed.
Medical therapy such as DHT blockers and hormonal replacement can potentially optimize the longevity
of hair growth.
Hair loss is still going to progress.
However, the option to improve your scalp coverage with one to two treatments performed
over a 2 year period with longevity of benefit being typically 3 to 5 years and in many situations
even longer is far more accessible, convenient, less risky and more economical than surgical
hair transplantation.
Since 2011, I observed the hair loss profiles of a wide range of patients who came from
around the world and developed a classification system for hair loss for men and women.
This classification is used to create customized treatment plans based on gender, age, age
of onset of hair loss, rate of progression, degree of hair loss and other medical variables.
I find that during consultation, I generally suggest hair transplant to be something to
consider as a last option after achieving the full results of TrichoStem® Hair Regeneration.
99 plus percent of my patients don’t pursue hair transplant after TrichoStem® Hair Regeneration.
I’ve observed that most people look for a hair loss solution after they’ve passed
a certain threshold of hair loss.
This motivates them to pursue a solution.
I find that once there is a significant improvement and a stable appearance for several years,
they feel better and less anxious about their hair.
In fact, many people who’ve undergone hair transplant come for TrichoStem® Hair Regeneration.
As mentioned earlier, since hair transplant does nothing for hair loss progression, many
people who’ve had hair transplant have come to manage their thinning hair rather than
undergo a second hair transplant operation.
In addition, we’ve treated many people who want to optimize their hair transplant results
by coming in within the first three months after their surgery.
The benefits of improving the hair transplant healing process coupled with the reactivation
and thickening of existing hair helps to optimize scalp coverage after surgery.
In conclusion, the best way to minimize hair transplant scars is to not have a hair transplant
at all.
If hair transplant is going to be necessary, then I would suggest considering non-surgical
options to maximize the coverage and longevity of your existing hair before considering hair
transplant surgery.
For people who want hair in a smooth and bald area, if there is hair present in the mid
scalp and crown, a procedure like TrichoStem Hair Regeneration can improve the total scalp
coverage so you won’t need to be as aggressive with surgical hair transplant.
I hope you found this information helpful, thank you for your question.

Surgical Double Chin Treatment can be more Convenient than Non-Surgical

Is Kybella® a good procedure for double chins? There’s been a lot of excitement
about the product Kybella® after introduction to the market in 2015
Allergan the company behind Kybella® obtained FDA approval for the
non-surgical dissolution or dissolving of fact under the chin also known as a
double chin or medically referred to as submental fat there was often a lot of
buzz for any new non-surgical treatment as an alternative to surgery
so is Kybella® a more effective and convenient treatment for people looking
to address their double chin in comparison to a surgical procedure I’ll
discuss how I looked at kybella as an option 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 have been treating the double
chin or submental fat area throughout my career using different methods of
liposuction or facial liposculpture as well as non-surgical long pulsed 1064
yaga laser although I’m trained and practiced as a surgeon I routinely
integrate non-surgical procedures in my practice to help my patients in the best
way I can I’ve always pursued my training and
ongoing education by integrating information and experience from multiple
specialties to do what matters most helping my patients in the safest most
predictable and beneficial way being in practice for so long I’ve witnessed such
hypocritical self-interest and Inter specialty rivalry
has resulted in an erosion of the general public’s trust in the medical
profession every physicians single mission should simply be to put the
patient’s best interest above everything so let’s take a look at kybella the
active ingredient in Kybella® is a chemical called deoxycholic acid deoxycholic acid
naturally exists in your bile which is stored in your gallbladder and is used
for the digestion of fat it makes sense that the same chemical for fat digestion
in your intestines can be used for fat dissolving under the skin people who
want to improve the appearance of double chin are understandably excited
about being able to have their double chin improve without surgery the catch
is that kybella can take up to six treatment sessions to achieve the
desired result which means you have to have multiple injections over multiple
sessions these injections typically cause swelling as well as skin
discoloration for extended periods of time the ability to control the amount
of fat being dissolved is difficult with Kybella® since a liquid injected under
your skin can spread to areas where you don’t want it to go this is a problem
because a certain layer of fat directly below your skin is beneficial for
healthy as well as youthful looking skin as mentioned earlier my objective is to
help my patients by recommending procedures which are safe highly
predictable and allow for quick recovery many people are afraid of the word
surgery and many non surgeons as well as non physicians unethically take
advantage of this fear for their own financial benefit I’ve helped many
patients who are apprehensive about surgery come to understand some basic
prints one entering the skin with a needle is
an invasive procedure subject to many of the same complications as surgery to a
surgical procedure performed under general anesthesia can be safer and more
predictable than a non-surgical alternative by using local anesthesia in
my practice I routinely reduce fat under the chin and jowls with local anesthesia
and LITE IV sedation as per the patient’s preference I’m able to sculpt
the fat which means being able to protect the skin and allow the retention
of the healthy layer of fat needed for smooth looking skin the procedure takes
little time to perform and the benefits are appreciated in real time the
patients can go back to work within a few days and they don’t typically need
any additional sessions the highly aggressive marketing of kybella
by both the company and the practitioners hoping to profit from
another cosmetic retail service has resulted in everyone concerned about the
appearance of their neck to think that Kybella® is the way to go there are some
limits to both facial liposculpture and Kybella® if you are significantly
overweight for example it’s important to understand through a proper evaluation
how much of the appearance of the under chin and neck area is related to fat
that is accessible and how much fat is in the deeper tissue which is not
accessible optimally a treatment like facial liposculpture is done for
stubborn fat not diminishing in spite of you being close to your ideal body
weight loose skin under the neck is not due to fat but from skin and soft tissue
sagging associated with age or from significant weight loss generally this
needs to be addressed by some type of lifting
procedure floating the excision or removal of redundant skin for example if
the loose skin is due to aging then a neck lifting procedure may be
appropriate for people with moderate skin laxity a minimally invasive suture
suspension neck lifts may be performed without the need for more extensive
surgery if there is a small amount of fat and skin laxity a non-surgical gel
lift procedure such as a long pulsed nd-yag laser treatment can both reduce
fat and contract the skin to create better jawline definition another issue
which is not addressed by facial liposculpture and Kybella® is the
appearance of platysmal bands the platysma muscle starts at the base of
the neck and runs up to the sides of the neck all the way to the chin lattissima
bands can be addressed with the neurotoxins such as botulinum toxins in
Botox Dysport Xeomin and Jeuveau if there is also significant skin laxity
then a neck lift is also an option the appearance of excess volume under the
chin can also be caused by the natural anatomy of having a low hyoid bone the
hyoid bone is responsible for the angle between the chin and the neck a low
hyoid bone can create the perception of having a double chin loose skin under
the chin can also be associated with the deficiency in the bone structure which
can be caused by genetics aging or a combination of the two I perform a
procedure called Structural Volumizing where I place long-lasting hyaluronic
acid fillers such as Juvederm Ultra Plus and Juvederm Voluma in a way which is
comparable to the placement of facial implants by enhancing the bone structure
of the cheeks the chin and jaw angle and neck skin the elevated neck skin and the
facial proportions can look significantly better while having a
non-surgical treatment to improve the appearance of a double chin may be
attractive it’s important to recognize that there are many different anatomic
issues which can all be described as a double chin this means that a proper
examination by a doctor without any bias is the first step to your understanding
what treatment strategy is best for you if you have fat under the chin and you
are in a healthy weight range with good skin tone the question is which is a
better option Kybella® or facial liposculpture in my opinion I am serving
my patients better by performing facial liposculpture with local anesthesia
rather than having them come in for multiple sessions with less
predictability and more total recovery time using Kybella®
I hope you found this information helpful thank you for your question