Acne Scars Why There is No Best or One-Off Treatment

What is the best treatment for acne scars?

Acne scar management requires proper evaluation and clear communication about
expected outcomes and long term strategy. It’s very important to understand that one
strategy for acne scars doesn’t apply to everybody. And it’s not usually a single
one off process where we do one thing and then you’re done. When you seek
opinions from doctors regarding acne scar treatment keep in mind that you
will get different opinions. Because there is more than one way to approach
these issues. Practitioners make recommendations based on a perspective
of experience. And often whatever is the latest branded device they’re currently leasing.

I’ll discuss the steps I take in evaluating a patient with acne scars. And
how I make my recommendations and set expectations.
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 wide range
of procedures for patients with acne scars. Including lasers, use of
radiofrequency technology, skin boosting, regenerative medicine technology such as
PRP or platelet-rich plasma, and a cellular matrix as well as acne surgery
such as subcision, scar removal, and skin grafting. When I look at a patient with
acne scarring I take high-resolution digital photos.
And I also take photos with the method called backlighting. To look at the
shadows which provide me with information about the depth and extent
of the scars. Acne scars are typically classified as rolling scars Boxcar scars
and ice pick scars. There are different levels of all these
scarring and a strategies developed based on these specific classifications.
When you’re dealing with acne scars you are dealing with one common issue. Tissue
loss the underlying strategy is to maximize the volume where tissue is
deficient. And to blend the interface between the normal skin and the adjacent
area of tissue loss. Unfortunately many people with acne scars literally jump
from one laser to another based on aggressive marketing. Resulting in
frustration and disappointment. A very important limitation is the generally
accepted standard amongst ethical professionals. As to the maximum level of
change that can occur with acne scars. Generally speaking improvement of about
20 percent followed by maintenance procedures is a realistic expectation. Of
course the term twenty percent can be up for subjective interpretation. For my
patients I find that defining success as an improvement avoids unrealistic
expectations. My approach to acne scars is comparable to my approach with facial
aging. I create a customized strategy to work from the inside outward. For example
if the cheek volume can be enhanced I will place a long-lasting filler such as
Juvederm Ultra Plus or Juvederm Voluma at the bone level. The improvement in
projection can have a significant effect on softening the appearance of acne
scars. This becomes particularly relevant with the natural progression of facial
aging. I also see how improvement in volume and facial balance can shift
focus away from the acne scars at the skin level. Although it is commonly
accepted that various lasers can help depress cars by controlled injury which
then stimulates a healing response by cells
in the skin called fibroblasts to produce collagen. The question is how
much of a difference can be achieved when the tissue is scarred? In addition
how much collagen generation can occur when the patient has had one or more
previous laser radiofrequency or micro needling procedures?
I find myself consistently integrating the use of PRP or
platelet-rich plasma. To induce collagen production without causing any
significant injury as a first-line before or in conjunction with non
ablative laser treatment. PRP or platelet-rich plasma not only stimulates
collagen production but also improves blood supply and softens the scar tissue
in particular for patients with Boxcar scars. I find this strategy useful. I
routinely combine PRP with hyaluronic acid filler. Which is delivered to the
dermis using a procedure called skin boosting. Rolling scars and scars
associated with the lack of underlying fat are often managed through a
combination approach. Procedures such as subcision injectable fillers are placed
on the bone level below the skin and in the dermis that combination can be very
effective. There is also a type of ablative laser technology often
beneficial particularly for Boxcar scars. These are scars with very sharp defined
edges. Generally when using a laser we try to soften the edges of these scars
and then blend the skin so that the skin heals smoothly for improvement.
Another approach which is more convenient and beneficial particularly
for shallow scars is water-based microdermabrasion. Or a procedure that
has called HydraFacial there is no downtime and the improvement in the skin
can be appreciated immediately afterwards. I recommend that any
therapeutic strategy for acne scar involve regular follow-up examinations
and some maintenance. Procedures which are customized to the individual in a
time where devices get aggressively marketed and unrealistic expectations
are promoted, it’s more important than ever for you to find a physician who you
trust. To have your best interest at heart all
too often new devices come on the scene and many doctors buy or lease these
devices. And then think only about the profit from the transaction and have no
interest in a long-term management plan. I recommend you meet with experienced
doctors and make sure you feel that you are being well informed and you have
confidence in the doctors treatment plan for you. And what the short-term and
long-term outlook will be. I hope you found this information helpful. Thank you
for your question.

Effects of Brow Lifting on Eye Appearance

Should I get a brow lift to make my eyes look more open?

The appearance of your eyes regardless of your age can be the key to how you are perceived by everyone
who interacts with you a lot of people who want to improve the appearance of
their eyes look in the mirror and raise their eyebrows using their forehead
muscles as well as their fingers to lift their eyebrows based on these actions
it’s understandable to believe that a brow lift procedure can be the key to
enhancing the appearance of your eyes I’ll discuss how I advise my patients
about the benefits and the downsides of brow lift surgery I’m Dr. Amiya Prasad
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon I’ve been in practice in the New York City
and Long Island area for over 25 years I perform several different types of
surgical brow lifts as standalone procedures I also often combined brow
lift surgery with cosmetic eyelid surgery and face lift surgery I perform
different types of non-surgical brow lifts in addition using neurotoxins like
Botox, Dysport, Xeomin and Jeuveau in addition to neurotoxins I also use
hyaluronic acid fillers to provide brow support and elevation as part of a
non-surgical brow lifting strategy I’m well known for performing cosmetic
eyelid surgery as well as specialized procedures not typically performed by
general plastic surgeons such as eyelid ptosis surgery eyelid retraction repair
and revision eyelid surgery for complications after procedures were
originally performed by other doctors when considering
surgery for the eyebrows it is often underappreciated how much
the eyebrows contribute to your facial expression for example your eyebrows may
not be an area of focus but as soon as they are trimmed shaved or if you have
microblading done they become a more prominent facial feature not always in a
good way this means that any change in your
eyebrows can have a significant impact on your facial appearance or expression
the shape of your eyebrows can convey anger sadness and surprise with the
slightest alteration so with this understood any cosmetic
procedure that may alter the brow height and shape needs to be carefully planned
with the expected outcome to be as predictable as can be is generally
understood that brow lifting surgery can result in you having a stereotypical
plastic appearance in entertainment these excessively arched eyebrows or
overly tight faces have essentially become a meme
there are several surgical options for brow lifting and brow shaping as is for
any cosmetic concern we need to be clear about the diagnosis of the problem
before defining the solution I perform surgical brow lifts when the brows have
descended or drooped this is referred to as eyebrow ptosis ptosis means drooping
and the eyebrows can descend and have a negative impact on the appearance of
your eyes my approach to eyebrow lifting is to
subtly reshape the brows so they frame the eyes in a way which is proportional
and harmonious and look natural in my practice of over 25 years I’ve performed
a full range of brow lifting procedures these include
coronal brow lift, endoscopic brow lift hairline trichophytic brow lifts
temporal brow lifts and direct eye brow trichophytic brow lifts I recognized many
years ago that like fashion there are trends in the aesthetic field in the 80s
and 90s high and arched brows for women was considered the ideal in the
aesthetic field I found myself at that time questioning this aesthetic since
many people were getting brow lift surgery for brows which had not drooped
I have different perception and my approach then and to this day is to
restore or shape the brow rather than doing a generic brow lift
as mentioned earlier I perform a lot of non-surgical brow lift procedures to not
only lift the brows but to address a limited amount of skin excess over the
eyes botulinum toxin can be strategically placed to elevate the
eyebrow by several millimeters the way it works is by relaxing the forehead
depressor muscles such as the procerus corrugator and orbicularis oculi muscles
this group of muscles pulled the eyebrows downward so by relaxing the
depressor muscles the muscles that lift the brows called the frontalis muscle
works unopposed this effect can last as long as six months but patients usually
come in at four months so that before the effect completely wears off brows
can also droop due to volume loss caused by bone and soft tissue deficiency this
can be seen where the temples actually become more hollow that occurs with
aging I place a long-lasting hyaluronic acid filler at the bone level to restore
support and therefore elevate the eyebrows this strategy can be part of a
structural volume correction
of other areas such as the cheekbones jawline and chin one of the techniques I
frequently used for brow lifting or as I prefer to define it as eyebrow shaping
has been more accurate and predictable in my hands as stated earlier the
eyebrows often drew up and descend due to loss of bone volume caused by aging I
created design and I placed the incisions in a way that creates a
natural shape I also perform the procedure in a way to allow the eyebrow
hairs to actually grow through the incision which is called a trico fitting
incision I further improve the appearance of a surgical area by using
advanced wound healing material like extracellular matrix by a cell and
platelet rich plasma also called PRP another benefit is that the use of
extracellular matrix and PRP can also help thicken eyebrow hair that has been
thinning eyebrow hair thinning is often associated with aging I’ve been using
extracellular matrix and PRP for the non-surgical treatment of genetic
pattern hair loss for men and women and we call that TrichoStem Hair
Regeneration which I developed starting in 2011 men and women with genetic and
hormone related hair loss have come to us from around the world to our offices
in New York Long Island and Northern Virginia when your eyes look hooded
without the presence of eyebrow ptosis I recommend cosmetic upper eyelid
surgery cosmetic eyelid surgery can open up the eyes by addressing excess skin or
redundant eyelid skin soft tissue and fat when performed artistically and with
the right amount of contouring and removal of skin fat and soft tissue it’s
remarkable how cosmetic eyelid surgery can brighten the whole face
since I design and perform cosmetic eyelid surgery to maintain facial
character you look like yourself my patients often report how their friends
and families recognize that they look better they just can’t figure out why I
addressed concerns about potential risks by explaining that expertise and
experience is the way to reduce risk in any endeavor whether it’s flying a plane
or performing delicate eyelid surgery expertise and experience is critical to
reach a level where you can be artistic if you were to play the piano your
ability to compose is dependent on your mastery of piano skills for example in
eyelid surgery I designed the skin removal and the eyelid crease by
factoring in the skin quality and elasticity the way a sculptor
understands the material they’re working with so that the any sign of surgery is
barely if at all perceptible I perform both eyebrow lifting and eyelid surgery
using local anesthesia with LITE IV sedation and completely avoid general
anesthesia if you have general anesthesia you have to be paralyzed and
rely on a respirator to breathe for you many people after general anesthesia
experience nausea and vomiting as well as need an overnight stay at a facility
before they’re able to return home in comparison with what we do with local
anesthesia and Lite IV sedation my patients are comfortable during surgery
and breathing on their own and they go home in about two hours after surgery
smiling and thanking my staff the eyes are so important for all types of
interaction the aggressive retailing in the aesthetic field creates a false
equivalency in the marketplace which has harmed
countless people particularly those who are trying to save money this area is so
critically important for both your appearance and your vision I cannot
stress enough the value of a proper consultation so you understand if
eyebrow surgery is appropriate for your situation I hope you found this
information helpful thank you for your question

My Face is Uneven. What Should I do

What can I do about facial asymmetry? It seems that many people are aware that
having good facial symmetry is a characteristic seen in some famous
people and is considered to be a desirable quality to have facial
asymmetry particularly cheek asymmetry is a common concern I get asked about
fairly often I found that even some young people who contact us are very
concerned about their facial asymmetry facial asymmetry is of course natural
and everyone has it to an extent including the actors and models who
appear to have perfectly symmetric features I’ll discuss what contributes
to normal facial asymmetry and when I feel it should be left untreated and
when facial asymmetry can benefit from an aesthetic procedure
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in New York City and Long Island for over 25 years for facial
asymmetry I perform a range of facial filler treatments such as for the lips
the cheeks and chin as well as surgeries such as cosmetic eyelid surgery and
facelift surgery facial asymmetry is mainly the result of the facial bone
structure the face forms has two separate sides which come together to
meet in the middle this normal development of facial bone structure
will naturally have some degree of asymmetry for example one cheek bone can
appear to be projecting more than the other or the eyes are set slightly
differently in height or position relative to each other
generally speaking facial asymmetries unless very significant rarely draw
attention it’s interesting that when people often ask about improving facial
asymmetry they disregard other aspects of their appearance which can have a
potentially greater impact on how they look I find that a lot of my patients
who work in front of a camera are acutely aware of these subtle
differences between the two sides of their face
although bone structure cannot be changed with routinely performed
cosmetic procedures enhancements are possible for better overall appearance
facial asymmetry can be more noticeable when there are genetic volume
deficiencies such as one cheek having a noticeable difference in volume and
shape when compared to the other this genetic condition can occur in young
people and can be treated on a case-by-case basis
I would only consider these cases when volume differences are significant and
are easily noticed by others I normally don’t treat nor do I recommend treatment
for younger people with facial asymmetry that falls within the normal range the
differences in facial symmetry can actually become more significant with
aging as we get older we lose facial volume from diminishing bone muscle fat
soft tissue and skin the most significant volume loss from aging is
due to bone volume loss this volumetric loss is often overlooked with more
attention directed to the appearance of sagging skin
I see facial bone and soft tissue volume loss as a more significant part of
facial aging which actually precedes the excessive skin and soft tissue descent
age-related volume loss can actually accentuate facial asymmetry this is
because facial asymmetry can be less noticeable in
younger and fuller face so with aging and more noticeable loss of facial
volume facial asymmetry can appear to be more pronounced for facial volume
enhancement I would surgically place facial implants these implants made of
soft silicone are known as malar and sub malar implants with the cheeks and chin
implants for the chin in recent years with the introduction of more advanced
and longer-lasting hyaluronic acid fillers addressing
facial volume has become much more convenient safer and highly predictable
thicker longer-lasting hyaluronic acid fillers such as Juvederm Ultra Plus and
Juvederm voluma are appropriate for areas like the cheeks and chin softer
fillers are used under the eyes or in the lips a common objection raised is
how facial fillers can create a doughy look when the face looks pillowy and
bloated this look is most often due to facial fillers being placed at a more
superficial level or just below the skin the fat and soft tissue space that these
fillers get placed into lacks the strength and intrinsic structure to
support these fillers so naturally they migrate and create this stereotypical
soft and doughy look most injectors are using this approach what I do for my
patients is to apply my knowledge as a face lift and facial implant surgery to
place these same fillers deeper at the bone level which works has a much
stronger foundation for these thicker fillers when in comparison to this soft
tissue space by placing fillers at the bone level the fillers can add structure
to the face as it enhances and restores facial structure and definition
we call this Structural Volumizing I place these fillers using blunt cannulas
instead of needles so I’m able to glide through the facial anatomy rather than
pierce and tear the tissue with needles at the bone level the materials kept in
place by the muscle layer above it so you look more natural and more defined
there’s essentially minimal risk of migration so you can be confident that
you won’t have a soft or doughy look most doctors and mid-level injectors
don’t place fillers at the bone level even when they think they are
this meant that I’m describing is highly technique dependent after a Structural
Volumizing there’s typically little to no downtime patients can actually look
pretty good the next day and I see my facial filler patients about two weeks
after the procedure to see how the filler materials have settled and to see
if additional filler material is of benefit I feel that it’s always better
to be a little conservative initially with filler placement and then add a
little more later if needed another advantage of hyaluronic acid fillers is
that they can be easily dissolved with the enzyme hyaluronidase essentially
making them reversible patients can sometimes ask for semi-permanent or
permanent filler materials I advise them that these fillers are not reversible
and can require extensive surgery for removal if needed I’ve performed these
types of surgery for people who come to me from around the world so I know how
complex a problem these permanent fillers can become hyaluronic acid on
the other hand naturally occurs in the body and is safely metabolized with time
for most cases of facial asymmetry especially among younger people no
treatment is advised because facial asymmetry is not
and normal and usually it’s not detrimental to your general appearance I
feel that treatment for facials asymmetry is only recommended where
facial balance is affected and is noticeable and when volume deficiency is
affecting your natural facial harmony which is typically seen with facial
aging I hope you found this information helpful thank you for your question

Surgical and non-surgical treatments for jowls transcript

The term “jowls” tends to be a general term to describe the appearance of a jawline,
which is not well defined.
Although “jowls” is commonly associated with facial aging associated with sagging
skin, many younger people come in to our office complaining of having “jowls”.
There is considerable confusion about how to improve the jawline since the marketplace
is saturated with “miracle” solutions.
I’ll discuss how I help my patients improve the appearance of their jawlines everyday
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.
My approach to jowls was first established through performing surgical procedures such
as liposuction for better jawline definition and the full range of face and neck lift surgeries.
In addition, I routinely placed chin and pre-jowl implants for this purpose.
This knowledge of deeper facial anatomy has been the basis for the evolution of my approach
using non-surgical solutions for treating jowls, which I will describe in detail.
In my daily practice, patients come asking for procedures, which they learned about online
and from their friends who may or may not have had the procedure they’re interested
I explain to them how it’s first necessary to understand the anatomical basis for their
appearance before discussing treatment options.
Large cap companies with big marketing budgets very effectively influence the consumer into
believing that their product is new and of course better than everything else.
Rarely is this actually true, scientifically speaking.
So let’s start with understanding the anatomy of “jowls”
As I mentioned earlier, the term “jowls” is often applied to the lack of a clear and
well-defined jawline.
This can be attributed commonly to a relative bone deficiency, excess fat below the jawline
and loose, sagging skin.
There are situations where one or combinations of these anatomical issues are present at
the same time.
When it comes to a situation of relative bone deficiency, there are several aspects of the
bone called the mandible where this deficiency can be present.
These include the chin or mentum, the jaw angle and an area of indentation called the
mandibular notch.
The cause of this deficiency can be familial, essentially characteristics which are inherited
as well as from aging.
Contrary to common perception, which focuses on the skin changes related to aging, diminishing
bone volume has a more significant impact on your appearance.
Typically in your 40’s to 60’s depending on your genetics, bone volume loss has more
effect on the jawline than skin sagging.
I approach this issue by applying the surgical principles used for the placement of facial
implants to the nonsurgical placement of long lasting hyaluronic acid fillers such as Juvederm
Ultra Plus and Juvederm Voluma.
This is called Structural Volumizing.
This means that I’m precisely placing hyaluronic acid filler at the bone level to restore and
enhance the contour where the deficiencies are present.
I routinely perform this procedure in my exam room with minimal discomfort, minimal risk
of bruising and in minimal time.
Bone volume loss also affects the cheekbones, which also support the skin that drapes along
the jawline.
With this concept in mind, I routinely enhance the cheekbones at the same time.
I would also add that the balance of the cheekbone projection with the jawline is important in
how the jawline is perceived.
By applying the golden ratio of or the proportion of 1.6 to 1, the face looks more balanced
and the jawline appears more youthful.
If the anatomic basis for the jowls is fat under the skin and the skin tone is good,
then my approach is to perform suction assisted lipectomy or liposuction.
This procedure takes very little time and is performed with local anesthesia and sedation.
I often find that fat below the jawline is often accompanied by fat under the chin, so
I will routinely treat this area as well.
This approach is safe and efficient.
Ironically, a product made of a bile acid called deoxycholic acid has been aggressively
marketed as a nonsurgical option for fat reduction under the chin.
My concern is that the procedure requires multiple sessions over several months with
significant swelling and inflammation after every session.
In my opinion, this describes a product, which is new, although deoxycholic acid itself is
not new and it has been around for years and is in no way better than what I do with a
cannula and a syringe in a just a few minutes of time.
The idea that the injection is a nonsurgical option misses the fact that injections into
the skin and creating inflammation is more invasive and requires much more recovery than
my approach.
Another issue related to fat that can also contribute to the appearance of jowls is the
buccal fat.
Buccal fat is a specific structure composed of fat that is located in the cheeks.
In some people, as they get older, some part of this fat decreases in volume and the supporting
structures get loose resulting in the fat creating a bulge adjacent to the jaw creating
a jowl appearance.
This is not fat that can be reduced with liposuction nor would I use deoxycholic acid.
For this prolapsed buccal fat, I work from the inside of the mouth and access the buccal
fat through a small opening inside the cheek.
I routinely perform this procedure with local anesthesia with minimal sedation.
The benefits of buccal fat reduction can be quite significant.
If there is a jowl with skin laxity, I assess the degree of skin laxity to determine if
you’re a candidate for a procedure called a “jowl lift” where I use a long pulse
1064 YAG laser or whether to perform a surgical facelift procedure.
The jowl lift procedure involves the use of a 1064 YAG laser to heat the skin and the
fat from the outside to a target temperature, which induces both fat destruction and skin
This procedure is performed in an exam room and takes about 15 minutes per session for
about 3 to 4 sessions spaced about 1 month apart.
This procedure is best suited for people who have good skin tone or the skin is not very
When the skin is loose and the jawline is not well defined, a facelift or face and necklift
procedure is generally the appropriate option.
This procedure is not just lifting sagging skin but it’s also addressing the underlying
tissue connected to the facial muscles called the SMAS or superficial musculoaponeurotic
This deep tissue is the foundational support of the skin and is often referred to when
a patient asks about “tightening the muscle” during a facelift.
I perform face and neck lifting procedures using local anesthesia with LITE IV sedation.
In addition to avoiding general anesthesia I use advanced wound healing technology such
as acellular matrix for better healing of the incisions.
My patients are comfortable during and after surgery, and are able to go home with a minimal
facial dressing.
My patients go back to work in 1 to 2 weeks with better looking jawlines.
I do emphasize to my facelift patients that your appearance after facelift surgery also
is also affected by the underlying bone structure and your skin elasticity.
You can think of facelift surgery as a way to restore the anatomy of the sagging tissue.
Your appearance can be further enhanced by addressing the age related bone volume loss
with Structural Volumizing.
Not having a well-defined jawline due to the appearance of having jowls can be very distressing.
It’s generally appreciated that people who are considered attractive, regardless of age
tend to have nice facial definition and harmony characterized by well- defined jawlines.
In the current environment, there are all kinds of skin level devices and dissolvable
threads creating a lot of buzz through aggressive marketing and absurd claims.
It’s important to understand the anatomical principles for your situation so you can avoid
being mislead by flashy marketing.
I always tell my patients that you define the problem before you work on a solution.
For example, if the appearance of jowls is due to a relative bone deficiency, even a
subtle improvement of the jawline through Structural Volumizing can make a significant
impact on how you feel about your appearance; and the results are appreciated immediately.
In conclusion, your facial bone structure, the presence of fat under your skin or in
the buccal space and your skin tone can all be addressed safely and effectively to help
you keep your jawline looking its best, at any age.
I hope you found this information helpful…thank you for your question