Archives: Transcript

What are the risks associated with eye bag removal surgery?
Eye bags are a concern for many people who come to my practice.
Mostly their concerns are centered around how tired or older their eye bags make them
look, and how often they are subjected to friends and family asking about whether they’re
getting enough rest or having a bad day.
The most common statement patients tell me is how tired they are of looking tired.
In reality, eye bags that are always present have nothing to do with how much sleep you
are getting.
Eye bags are an anatomic issue caused by something called lower eyelid fat prolapse.
Lower eyelid prolapse means the fat pockets around the eyes have pushed forward, resulting
in a bulge or herniation of fat that gives that puffy, tired appearance.
There are a few ways to address under eye bags depending on how severe they are.
Mild under eye bags can be improved by injecting filler into the hollow areas of the tear trough,
thereby camouflaging the puffiness.
More pronounced under eye bags, however, will require surgery.
Concerns about the risks of under eye bag surgery is something I address every day in
my practice.
I’m Dr. Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I first trained in eye surgery before training in cosmetic and reconstructive surgery of
the eyes.
Helping people improve the appearance of their under eye area is a major area of focus in
my practice.
Eye bag surgery is a very common procedure I perform in my practice routinely pretty
much every day.
As mentioned earlier, significant under eye bags cannot be treated with filler in the
same way that mild under eye bags can.
This is because placing more volume into an area with a prominent eye bag will only make
it look puffier than it already is.
Surgery is the most definitive procedure for constantly puffy eye bags, and can help prominent
eye bags more effectively than an injectable filler can hide.
The objective of eye bag surgery is to remove and sculpt the fat pockets for a smoother
contour, as if you never had under eye bags.
Eye bag surgery can be approached in two different ways — via the transcutaneous method or
transconjunctival method.
The transcutaneous approach involves making an incision on the outside of the lower eyelid,
right beneath the eyelashes, through which the fat pockets are addressed.
This is in contrast to the transconjunctival method, where fat pockets are addressed through
the inside of the lower eyelid, so no external incision is made,
In my practice, I typically prefer using the transconjunctival method.
Although it can be technicality more challenging , I have found this approach to have consistently
successful outcomes.
Oftentimes, when doctors operate via the transcutaneous method, fat is removed, and what is seen as
excess skin is trimmed to reduce wrinkles, then sutures are placed to close the lower
eyelid incision.
This approach to the lower eyelid, can compromise the delicate support system.
While a well-performed surgery can make the external incision barely noticeable, a scar
of varying visibility is still present where the incision was closed.
Unnecessary skin removal can cause a skin shortage that ultimately leads to complications
such as ectropion and contribute to eyelid retraction.
Ectropion is what occurs when the lower eyelid becomes everted, or turned outwards,.
Eyelid retraction is the downward displacement of the lower eyelid, resulting in a rounded
look to the lower eyelids, and too much of the white part of the eyes being exposed called
scleral show.
In some cases, the eyelids are unable to fully close and the natural distribution of tears
is affected, leaving the inner eyelid and eye itself prone to irritation or infection.
As I mentioned earlier, I prefer the transconjunctival approach.
It’s a technically advance minimally invasive strategy.
This method allows me to address the fat pockets without compromising the integrity of the
support structures in the lower eyelid.
The natural eye shape is better preserved, there is less trauma around the eyes which
minimizes bruising and swelling.
Since there is no external incision, there is no scar, you can look natural, even from
up close, like you’ve never had the eye bags.
Instead of removing skin to improve wrinkles, I approach under eye wrinkles as an issue
of skin quality, not skin quantity.
I use platelet-rich plasma, or PRP, which is derived from your own blood, and contains
wound healing and growth factors that can stimulate collagen and increased blood supply
to the under eye area, improving the health and quality of thin eyelid skin, and make
it thicker.
I also use laser or radiofrequency treatment to resurface and tighten the under eye skin.
In my practice, I perform transconjunctival blepharoplasty under local anesthesia with
LITE IV sedation.
This is as opposed to general anesthesia, which means that my patients are able to recover
faster and can go home after the procedure.
In fact a good number of my patients say that if they knew it was this easy for them, they
would have had the surgery much sooner.
Typically, patients return to work and daily life in one week’s time, sometimes even
less.
In most cases, our patients come back in a week and have minimal swelling and almost
no bruising.
There are risks with eye bag surgery, as with any type of surgery.
These risks can be minimized by choosing a doctor with a high level of expertise, experience
and artistry.
I hope you found this information helpful, and thank you for your question.

Can I choose between a parallel or tapered crease for my Asian double eyelid surgery?
Double eyelid surgery also called Asian eyelid surgery or Asian double eyelid surgery is a very
popular procedure worldwide it’s generally understood that about half of the people of
Asian descent are born without an eyelid crease which applies to people who are
Chinese Japanese Korean as well as other Asian ethnicities it’s often observed that the
absence of an eyelid crease can make the eyes appear smaller and even look tired or
possibly even angry this means that double eyelid surgery can make the eyes look bigger and brighter
people considering double eyelid surgery become aware of the different types of eyelid creases
for example the parallel crease is where the eyelid crease runs parallel
to the eyelid margin of the upper eyelid the tapered or nasally tapered crease it literally
tapers in towards the inner corner of the eye although most of my patients are interested in a
natural result I do find that it’s helpful to show my patients the difference between
these two types of creases and what my recommendations are for their specific situation
I’m Dr Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon I’ve been in practice in New York City and Long Island for
over 25 years I routinely perform all types of cosmetic eyelid surgeries such as helping people
who have under eye bags and hooded upper eyelids I also perform specialized cosmetic oculoplastic
procedures such as eyelid ptosis correction I’m well known for performing Asian double eyelid
surgery and as mentioned earlier i there are about 50 percent of Asians are born without an eyelid
crease of course this particular characteristic can apply to other ethnicities who have Asian
features now during consultation I’ll show the patient by using an instrument or a Q-Tip and
push back the eyelid skin where a natural crease would have formed if they had been
born with one now pushing the skin back this way also shows how the patient’s natural anatomy
would have determined whether their natural crease would have been parallel or nasally tapered
as far as a patient requesting a type of crease in my opinion forcing a type of crease that does not
fit your natural anatomy can result in an unnatural looking crease and make you appear
kind of plastic upon determining what kind of eyelid crease looks natural the next step is to
determine what kind of surgical procedure should be performed generally speaking there are two
types of double eyelid surgery approaches there’s an incisional or a non-incisional
option incisional surgery is usually performed in the presence of excessive skin fat or combination
of the two younger patients in their 20s and 30s usually don’t have excess skin or fat so I
usually perform non-incisional Asian eyelid surgeries for these patients with this technique
small openings are made in the upper eyelid so sutures can be passed through these openings to
in order to create a connection between the upper eyelid skin and the muscle that lifts the eyelid
called the levator muscle the area where the connection is made is where the eyelid skin folds
when the eyes opened thereby creating a crease where there wasn’t one before for older patients
who have some eyelid skin laxity due to aging and some prolapsed fat behind the upper eyelid
some eyelid skin and fat can be reduced so that these patients can have a proper crease
now sutures are placed to close the incision and like the non-incisional approach the incisional
procedure the crease is formed where the suture makes a connection between the eyelid skin
and the levator muscle I perform all my eyelid surgeries in my office operating facilities
using local anesthesia with LITE IV sedation thereby avoiding the risks and complications
associated with general anesthesia most of my patients are able to return to work in one week
or less with minimal swelling so although it’s possible to pursue a nasally tapered or parallel
crease by choice in my opinion it’s better to work within your natural anatomy so that
the eyelid crease you have after surgery appears natural and consistent with your facial features
I hope you found this information helpful thank you for your question

What’s the best procedure for eye bags? This question is an indication of the
level of confusion in the marketplace where physicians non-physicians device
manufacturers pharmaceutical companies and cosmetics manufacturers are
overwhelming the internet social media radio and television with claims of
offering the best solution for under-eye bags as an expert in helping people with
under eye bags since the early 1990s I’ll share with you my experience with
people who come to me after trying a lot of these new and improved ways to treat
under eye bags I’ll discuss my approach to evaluating under-eye bags and the
treatment strategies I developed for my patients 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 procedures to help people with their under eye bags
every day in my practice these procedures include lower eyelid surgery
and under eye filler treatments as well as lasers radiofrequency and PRP
procedures which are used to improve the under eye skin I also specialize in
revision procedures for treatments done by physicians and non-physicians these
procedures include dissolving under-eye fillers and addressing complications of
lower eyelid from I back surgeries such as lower eyelid retraction and ectropion
during consultation for under-eye bags I find that a lot of my patients come in
with a list of solutions which they learn after doing lengthy internet
research another group of patients come in after they’ve tried several
so-called non-invasive procedures which either didn’t work or actually made them
look even worse in the course of these discussions there is a common element to
these stories typically they report that they went to someone and that they were
recommended to have a procedure with a new device or an injectable as a shotgun
approach these so-called latest breakthroughs are aggressively promoted
and not surprisingly discounted as an incentive if something works so well why
should you need an incentive other than a successful result
so what was missing what was missing was a proper analysis of the anatomy and an
unbiased discussion about what are the factors which contribute to them looking
tired with under-eye bags so what I say to my patients is let’s clearly define
the problem before we plan the solution when you have under-eye bags which are
constantly present regardless of the amount you sleep the anatomic issue is
most often lower eyelid fat prolapse lower eyelid fat prolapse means that the
fact that is under your eyes herniates forward which we call fat herniation
this problem is generally associated with genetics as well as aging and other
variables such as allergies and sinus problems staying on anatomy I also look
at the bone structure in particular the cheekbone structure I often see prolapse
of fat forward occurring at the same time there is a deficiency in cheek
projection when referring to the cheek I mean the area just below the lower
eyelid seen from a front view as well as the cheek bone which is the high point
on the side next to the eye it’s not unusual for me to see a patient who
feels that they have under eye hollowness as their primary issue
the presence of under-eye bags this makes sense when you understand that the
relationship of the cheek projection to their fat prolapse this perception of
hollow is also caused by the contrast between the height of the under-eye bag
which is like a hill next to the hollow which is a valley resulting in the
perception of a hollow appearance the higher the hill the deeper the valley or
hollow in addition I look at the skin quality in terms of wrinkles tone and
discolorations it’s important to understand that the eyelid skin is the
thinnest skin in the body at about 1/2 millimeter in thickness the
recommendations I make to my patients is based on my experience as a cosmetic
eyelid surgery specialist with experience in multiple surgical and
non-surgical approaches I also own several lasers and radiofrequency
devices and I personally perform injectable treatments such as hyaluronic
acid fillers and neurotoxins the point is that I don’t have a bias based on any
limitation in education or training I select with my patients the approach
which I feel is in their best interest to achieve an outcome that they will
likely to be satisfied with I don’t lease any devices and I have no other
pressures which would make the recommendations I make if I think a
device or technology is effective I buy it outright and I use it when it’s
appropriate that being said let’s look at what defines an effective solution
for under eye bags or any cosmetic procedure in my opinion the procedure
should be one that I would do for myself or a member of my family
this means it should be safe predictable and have minimal downtime safe is
defined by minimal risk of complication from the procedure itself and anything
that could be a risk to your health predictable means that as your doctor I
can confidently anticipate a level of improvement which can be
shown to you in before-and-after photos minimal downtime means being able to go
back to your normal life quickly without a protracted recovery period where
you’ll look at yourself for weeks and months after the procedure and wonder
when you’ll finally look the way you want so here’s what goes on in my mind
when I see a patient who comes in with puffy eyes is there puffiness slight
enough with the bone structure anatomy which would allow me to effectively
camouflage their puffiness with under eye filler much is promoting about
the use of hyaluronic acid fillers as a non-surgical solution for under-eye bags
there are certain anatomic limitations to this approach the term tear trough is
now something anyone doing internet research becomes familiar with this
trough has two boundaries the boundary closer to the eye is the prolapse fat
the other boundary is a bone structure called the anterior lacrimal crest which
is part of a larger bone called the maxilla this bone defines how much you
can fill the tear trough before you exceed the capacity of the trough from
the front the height or projection of the prolapse fat defines the limit of
the fillers ability to diminish the relative prominence of the fat pocket
when the fat pocket and the anterior lateral crest are at about the same
height and there is a deep tear trough I can place a filler such as Restylane
with a blunt cannula and get a very nice result I often see people who had filler
place to camouflage their eye bags which resulted in their eye bags actually
looking worse I see this occur a lot when people insist that a doctor use
fillers when the fat pockets are much too prominent with no space for filler
placement these are the same people who believe
that they know enough to instruct the practitioner on how they should place
the fillers they end up looking worse and then they blame the practitioner for
their outcome when they really needed surgery and refused to accept the
reality that that’s the case I also see people who had too much filler placed
not only in the tear trough but also in the cheek from the front and sides
resulting in a disfiguring and unnaturally swollen appearance this
filler after being placed in the skin much too excessively causes swelling and
probably affects the lymphatic drainage system which further aggravates the
swelling in these patients I have to use large amounts of hyaluronidase to
dissolve the hyaluronic acid filler before doing anything else I often see
patients who did fillers for a few years to camouflage their under eye bags and
found that the fillers weren’t working so well as the fat prolapse became worse
and as facial volume loss from weight loss and aging progressed the next
question after establishing that the eye bags are caused by lower eyelid fat
prolapse is to what extent the individual fat compartments are
significantly herniating forward in the lower eyelid there are three compartment
which are also have deeper extensions and sub compartments the compartments
are the medial central and lateral fat pockets I have the patient look up in
several directions which make these fat pockets become more prominent I also
look at the supporting structure of the lower eyelid particularly the tendon
that is attached to the bone structure called the lateral canthal tendon when
the fat pockets are so prominent that filler cannot effectively be used for
blending a surgical option is appropriate
surgery is often portrayed particularly by non-surgeons as something to be
avoided at all costs I emphasize the word costs since these practitioners
cost their patients thousands upon thousands of dollars in useless
treatments it’s understandable that there are plenty of examples of
so-called botched plastic surgery in the media which contribute to this fear of
surgery I point out to my patients that the people who look natural after eyelid
surgery simply don’t draw attention so the fearful patient doesn’t get to
appreciate good cosmetic surgery results after so many years in practice a lot of
my patients come because they know someone I operated on and they like the
way the person I operated on looks resistance to surgery is also driven by
the fears related to anesthesia and anesthesia related complications in my
practice I perform eyelid surgery under local anesthesia with the LITE IV
sedation as opposed to general anesthesia where you’re paralyzed and
placed on a respirator to keep you alive my patients recover quickly and walk out
comfortable and happily thanking my staff before they go home as far as the
type of surgery is concerned my preferred approach to under-eye bags is
called transconjunctival blepharoplasty this is an approach where I address the
fat pockets from the inside of the eyelids in my hands my patients are able
to maintain the natural shape of their eyes which allows for retaining the
character of their eyes my objective when performing this type of eyelid
surgery is to create the appearance than you would have had if you never had
prolapsing fat pockets my patients recover quickly and go back to work in a
week often without any bruising as a side note I’ve seen patients who
reported having fillers done elsewhere and having been bruised for weeks
while my patients have minimal to no bruising one week after surgery
the next part is skin evaluation if you have lighter skin with wrinkles and
discolorations I often recommend fractional CO2 or erbium laser to
improve the skin quality and texture I also use PRP or platelet-rich plasma
which is a concentration of the healing factors from your blood which stimulate
collagen and blood supply resulting in better skin I use PRP for all skin types
and have found benefit for darker skin types who are not candidates for laser
as mentioned earlier the presence of fat prolapse resulting in under-eye bags is
often accompanied with a deficiency in cheek volume and projection associated
with genetics and aging bone structure determines the facial appearance more
significantly than anything else this means that addressing bone volume
can help you improve your appearance more effectively than any thermal energy
device or the latest innovations with threads the concept is called structural
volumizing where I use my experience performing facial implant surgery such
as the placement of cheek and chin implants to place long lasting
hyaluronic acid fillers I often enhance the cheeks at the same time I perform
surgery for under-eye bags the cheeks can be thought of as framing the eyes
and the balance of the cheeks with the eyes makes the whole face look better I
perform this placement without bruising and without any effect on the recovery
time after surgery I hope you found this information helpful thank you for your
question

What’s the best procedure for mid-face rejuvenation?
People dealing with facial aging particularly in the mid-face area will often assume that
they need a mid-face lift.
However, what is seen as sagging, or skin or tissue laxity may actually be more a loss
of projection and definition due to age-related volume loss.
I’ll discuss my experience, and my approach to mid-face rejuvenation.
I’m Dr. Amiya Prasad, I’m a Board-certified cosmetic surgeon, and a Fellowship-trained
oculofacial plastic and reconstructive surgeon.
I’ve been in practice in New York, and Long Island for over 25 years.
As a cosmetic surgeon focused on treating facial aging, I perform all types of facelift
surgeries, including mid-face lifts.
The experience and knowledge of facial anatomy as a surgeon has guided my approach to the
precise placement of cosmetic fillers at the deeper bone level to restore age related bone
volume loss.
I recall how in the late 90s, facial aging in the mid-face was seen as a problem caused
by laxity and vertical descent of the soft tissue in the mid face.
Different types of mid face lift procedures were being developed using new endoscopic
technologies.
Mid-facelifts are not the same as facelifts, which include SMAS facelifts, deep plane facelifts,
or short-scar mini facelifts.
Full facelifts are meant to address sagging skin, tissue, and as well as tighten the underlying
facial muscle foundation called the SMAS, short for the superficial musculo aponeurotic
system.
These different facelifts, which range with the extent of surgery appropriate for different
age brackets usually start with an incision along the front of the ear, and can extend
behind the ear, so skin be trimmed and lifted, the underlying muscle tightened, and soft
tissue repositioned.
The skin is then redraped, and the incision is closed along the front of the ear.
With mid-facelifts, only lifting the mid face is addressed, so the incision is made in the
temple for surgical lifting of this area only.
In my opinion, these midface lifting strategies addressed a small part of the more significant
cause for a deflated and sagging appearance in this area: Volume loss.
This doesn’t mean that there was no recognition of volume loss, as surgeons often advocated
combining midface lift and fat grafting to add volume.
It’s important to understand that as we age, bone, muscle, fat, and soft tissue decrease,
with bone loss being the most significant.
For example, cheek bone volume loss can make the skin over the cheeks appear to sag, as
the volume that once gave the cheek skin its structure and support is now lost.
Having performed mid-facelifts in the past, as well as surgical placement of cheek implants
to restore volume, I’ve changed my approach to the mid face by focusing on the bone loss
and using new techniques to approach this problem.
For most of my patients, I restore mid-face volume using a specialized method to place
long lasting hyaluronic acid fillers at the bone level in a way comparable to the placement
of facial implants.
Traditional filler placement at the mid-face is usually done at a more superficial level
of the soft tissue.
At this level the skin is unable to support any substantial filler volume.
The filler material will oftentimes migrate, so you can look soft, doughy, and even bloated.
With an understanding of the deeper anatomy of the face from performing facelift and other
facial surgeries, I’m able to precisely place filler at the deeper bone level, and
avoid migration that is seen when filler is placed in the soft tissue.
Placing filler at the foundational bone level actually improves the definition your facial
bone structure.
This method is called Structural Volumizing.
At this time, my filler preference are thicker hyaluronic acid fillers such as Juvederm Ultra
Plus and Juvederm Voluma.
Hyaluronic acid is found naturally in the body, so these fillers are quite biocompatible
and are safely metabolized with time.
We perform structural volumizing for the midface routinely in our office.
Many of our patients come in during their lunchtime and return to work right after.
Your results can be seen immediately after the procedure, however we allow for 2 weeks
to let the material settle into the space it was placed into.
I see my patients in 2 weeks and see if any enhancement would be of benefit.
Generally speaking, one of the first noticeable effect of aging in the mid-face is characterized
by volume loss, leading to you having less projection and definition.
As opposed to surgery and fat grafting, the strategic placement of filler at the bone
level can add structure, definition, as well a subtle lifting effect, without surgery.
I hope you found this information from my experience helpful.
If you’re interested in recommendations for your individual situation, you may contact
us through our websites or call our offices to schedule a consultation.
Thank you.

Defined and youthful cheekbones are often underappreciated until they
diminish with facial aging well-intended injectors place fillers under the skin
hoping the shape they molded under the skin during the procedure would remain stable
unfortunately the filler doesn’t hold its shape so results are either minimally noticeable
from underfilling or the person ends up looking doughy and bloated from overfilling
I find that many people are influenced by marketing and assume that the brand
of the filler is the basis for the quality of results in reality the brands of fillers such as
Restylane and Juvederm have a lot of comparable filler characteristics within their subcategories
these subcategories of fillers have different levels of viscosity which a practitioner can
easily select from so in actuality it’s the technique that defines the quality of the results
not the specific brand by applying a more advanced technique and deeper level of filler placement we
can achieve natural looking defined results which remain stable for typically one year or even more
this is called structural volumizing as the placement of material is at the bone structure
level in addition this placement technique allows for flexibility and convenience for our patients
as they don’t have to worry about having conspicuous swelling bruising or
very visible marks which are more of characteristic of typical conventional injection
methods many of our patients have their cheekbones enhanced over their lunch hour and they return
to work immediately afterwards I routinely see my patients after two weeks to see how they look and
review their before and after pictures so they can see the benefits of the improvement for themselves

Will lifting skin in my 40s help me look younger?
It’s fairly common for people experiencing the signs of facial aging to think that lifting
their skin will make them look younger.
Of course this perception has resulted in the marketing of “minimally invasive”
lifts, particularly threads and skin heating devices.
Although you may appear to look younger by shifting your cheek skin upward, there’s
more to facial aging then what you see from the outside.
I’ll discuss my approach to helping my patients who are considering a lifting procedure in
my practice.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
What is a youthful appearance?
A youthful appearance is characterized by facial balance, definition and vibrant skin.
Throughout my career my approach is to first determine the anatomical issues before developing
a treatment plan.
I am fortunate to have extensive experience in facial bone reconstruction and facial cosmetic
surgery.
As technology advanced, I’ve applied the knowledge from my surgical experience, to
performing nonsurgical procedures.
As I mentioned earlier, when a lot of people first think about facial aging, they think
about skin sagging.
During consultation, patients look in the mirror and lift their skin up to show me how
much better they look.
The question is “when is the right time to perform a lifting procedure such as a facelift?
Let’s begin by understanding the 2 most significant aspects of facial aging.
The first is the appearance of sagging and hollowing caused by bone loss.
My patients are often shocked to learn that facial bone volume diminishes as we age.
This is understandable, since we’ve all been exposed to the marketing of creams and
superficial skin treatments as solutions for the appearance of aging.
Pretty much every product claims to “lift and tighten”.
It’s well established in the medical literature the significance of bone volume loss with
age.
Many people in their 40’s and older become aware of their skin sagging and looking tired.
This is because the underlying bone structure decreasing in size results in less support
for the skin.
There are also many people younger than 40 who come in complaining of their skin sagging.
In actuality, their bone structure has some relative deficiency.
For example, someone can say that they’ve always had a weak chin or they never had good
cheekbones.
In my surgical practice, I have placed a lot of chin and cheek implants.
For the past several years I’ve been very able to achieve comparable results without
surgery.
I accomplish this by performing Structural Volumizing.
Structural volumizing means that with a very specific approach, I can place long lasting
hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma directly at the bone
level using blunt cannulas and improve the projection and definition of the facial bone
structure.
Restoration of structure allows the overlying skin to appear more toned and less sagging.
More significantly, the proportions of the face are more balanced.
This is based on the art of seeing the golden ratio.
The golden ratio is the ratio of 1.6:1 and is seen throughout nature.
Many actors and models, who are seen as attractive have facial proportions which are expressed
by the golden ratio.
My patients appreciate the improvement from structural volumizing immediately, since the
actual issue has been addressed.
This is in contrast to the current exaggerated claims of threads and heating devices.
I find it interesting that these procedures claim to make significant improvements, yet
they rely on months of collagen production to get the full benefit.
I find it particularly hypocritical that many of the “patients” who are used to demonstrate
these procedures are overwhelmingly people who don’t actually have a problem or are
considerably younger than the people who would come in for these treatments.
So when is a lifting procedure appropriate?
Well the second most significant aspect of facial aging is soft tissue laxity.
Once again, we have to look past the surface.
When I perform a facelift surgery, I always work on the supporting tissue below the skin
called the “SMAS” which is an acronym for “superficial musculoaponeurotic system”.
This is often simply referred to as “the muscle”.
Whether, I perform a short scar or a deep plane facelift, the SMAS is addressed in order
to allow the overlying skin to be repositioned most effectively.
I have found that my threshold for recommending surgical facelift has been changed from the
benefits of structural volumizing.
This means in general, I perform facelift surgery for patients who are their mid sixties
and older.
I look at it this way; if I were to perform structural volumizing, is the skin laxity
too significant for there to be a benefit?
I perform facelift surgery to reposition sagging tissue.
I educate my patients that bone loss is still an area that can be addressed.
This means that further improvement of facial appearance can be achieved with structural
volumizing.
In fact, I see a lot of people who had facelift elsewhere only a few years prior.
They say that they barely see a difference.
I’m sure they had a perfectly well executed facelift although they feel that the surgeon
didn’t pull them tight enough (which is unlikely).
I perform structural volumizing and they are very happy with the results.
This means that many people who’ve had facelifts in the recent past can potentially delay the
need for another facelift by addressing the underlying bone volume loss with structural
volumizing.
Once volume and definition has been achieved, what can be done for more youthful looking
skin?
Youthful skin is generally views as skin that is smooth, even in color and has a vibrant
glow.
Understanding that the skin is an organ like your heat and lungs means that what’s good
for your body is good for your skin.
Avoiding smoking and excess sun exposure with a good diet, sleep and exercise is a good
foundation.
Much of what I do for my patient’s skin in their 40s and beyond falls in 2 categories:
1) helping the skin from past exposures such as sun damage which causes discoloration and
wrinkling from collagen loss.
2) treating the skin for maintenance of appearance and slowing down of the changes from aging.
There is overlap of these two objectives with the more common procedures I perform.
For example, I use PRP or platelet rich plasma, which is a concentration of the wound healing
cells and growth factors needed when you have an injury.
PRP stimulates the production of collagen and improves the blood supply to the area
being treated.
I place PRP under the skin, which helps the fat cell layers under the skin.
This improves your skin’s glow.
I also combine PRP with hyaluronic acid using a micro-infusion device.
We call this skin boosting and the target is the dermis, which is the skin’s support
structure.
This is particularly beneficial for acne scars and fine lines.
For people with lighter skin, I improve skin discolorations with a Q switch laser, a procedure
we call laser skin toning.
There is essentially no downtime with skin boosting and skin toning.
Closing: If you’re in your 40’s and feel that lifting
your skin results in a more youthful look, think from the inside out rather than from
the outside in.
It’s easy to be influenced by influencers who are selling what they’re paid to promote.
Look for a physician to be your guide who you can trust to be your doctor for the long
term, not just for the deal of the week.
I hope you found this information helpful…thank you for your question

Is beauty more than skin deep? We’ve all heard that beauty is only skin deep, which
may be philosophically valid, but as far as the perception of external appearance, beauty
actually goes far deeper and is at the bone structure. We intrinsically recognize a youthful
face for its fullness, volume, definition, and proportionality. These attractive attributes
are foundationally provided by your bone structure. Models, for example are often described as
having “great bone structure” or “high cheekbones”. As we get older, not only are
there changes in the outer skin quality, but there is also diminishing facial volume. In
fact, in my experience, loss of facial volume actually precedes having significant skin
laxity. Generally, facial volume deficiency is more pronounced with aging, however, many
people naturally have genetic bone structure deficiencies, which can be addressed when
their as young as in their 20’s. As far as aging is concerned, facial volume loss
includes the loss of facial fat, soft tissue, and skin thinning, but the most significant
facial volume loss is at the bone structure. I’m Dr. Amiya Prasad, I’m a Board-certified
cosmetic surgeon, and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve
been performing facial rejuvenation surgeries including facelifts and facial implants for
over 25 years in New York, and Long Island. I routinely perform a lot of non-surgical
procedures such as injectable filler treatments to address age-related facial volume loss
and laser skin rejuvenation.
When you understand that facial volume loss occurs mostly at the bone level, it’s logical
to focus on enhancing bone volume. In conventional practice, most doctors and other injectors,
don’t address bone volume, but rather put filler at the skin level, or just below the
skin at the fat and soft tissue level. Anatomically speaking, these spaces cannot retain the well-intended
shapes created by the practitioner. Simply stated, the space just under the skin can’t
hold that much filler volume in one area so, the fillers tend to migrate, resulting in
you looking bloated, soft, doughy, and obviously unnatural. This appearance has been made famous
by certain celebrities and media personalities establishing the term “pillow face”. This
of course, frightens a lot of people who are afraid of looking unnatural. Every day in
my practice, I educate my patients that the filler itself isn’t what leads to the “pillow face”
look, but rather the way the filler was placed. What I do in my practice to treat volumetric
bone loss by placing fillers at the bone level. Most practitioners do not do this, as bone
level placement requires specific technical knowledge and experience in my opinion. Although
this is a non-surgical procedure using injectable hyaluronic fillers, I feel that surgical knowledge
derived from experience with facelift and facial implant surgery, helps me to place
the filler at the bone level with a high level of accuracy. The bone structure is a solid,
foundational structure of the face at the deepest level. This foundational stability
allows for more filler material to be placed than is conventionally performed, to create
a defined and proportional appearance, which looks natural. This is somewhat counterintuitive
since it’s often assumed that people who look doughy have too much filler in their
faces. This is to a degree accurate in that they may have had less volume than I would
place at the bone level, but what they have is too much volume for the more superficial
space the filler is located in. I’m often asked, why the filler doesn’t spread out
with my approach like it does in other people who look “pillowy”. Essentially, I place
the filler at the bone level which has muscle structure on top of the bone. The muscle layer
over the bone appears to hold the filler in place and prevents the filler migration that
everyone is afraid of. Our patients often report that their friends and family say they
look great, but they can’t pinpoint exactly why. Since adding foundational volume restores
much of the lost support structure of the face, the skin gains back its support, resulting
in a lifting effect to the skin. We call this technique Structural Volumizing as the filler
volume is restoring facial structure. It can be considered a non-surgical facelift for
people in their 40s and 50’s who don’t have significant skin laxity. I must emphasize
that this is not a replacement for a surgical facelift but rather a technique to address
a problem that a facelift does not address. In fact, many of my patients have had previous
facelift are delighted to have Structural Volumizing rather than another facelift. For
Structural Volumizing, I use thicker hyaluronic acid fillers that can last 1-2 years. Hyaluronic
acid naturally occurs in the body, so these fillers are safely and gradually metabolized
with time. Hyaluronic acid fillers can also be dissolved with the injectable enzyme hyaluronidase,
should the need arise. If you are looking into facial rejuvenation, remember that a
youthful appearance is not just the skin, but the bone structure that supports the skin.
If we’ve learned anything from the past, overtightened skin is not youthful. In my
opinion, looking youthful can be better characterized as looking healthy and vibrant. You can achieve
this with the right balance of volume, proportion and definition. I hope this information from
my experience helped you. If you’re interested in recommendations for your individual situation,
you may contact us through our websites or call our offices to schedule a consultation.
Thank you.

Are all surgeries for under eye bags done the same way?
I routinely see people concerned about having puffy under eye bags they state that the bags
under their eyes are always there regardless of what they do for their allergies or their
sinus issues as well as how much they sleep or how much salt they have in their diet
puffy eye bags that are always visible are likely due to something we call prolapsed orbital fat
this condition is also referred to as lower eyelid fat prolapse or
herniated fat lower eyelid fat prolapse is often a genetic feature seen in families
and something that can become more significant with facial aging a condition this common makes
lower eyelid surgery to address puffy under eye bags a highly sought after cosmetic procedure
the procedure to address under eye bags is called a lower eyelid blepharoplasty although this term
lower eyelid blepharoplasty is commonly used the procedure is not performed the same way by every
surgeon this can be very confusing for people who want to improve their under eye appearance some
of the most popular techniques are unfortunately prone to undesirable outcomes such as rounding
of the lower eyelids and even complications like lower eyelid retraction and ectropion
I’ll discuss different strategies and techniques for lower eyelid surgery I’ll cover some of the
key points of anatomy and surgical techniques so you can understand my recommendations
I’ll discuss the art of performing lower eyelid rejuvenation in a way that minimizes your risk for
complications and helps you look refreshed while preserving the natural character of your eyes
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 have been a strong advocate for natural results
and preserving individual character so people who know you can’t tell why you look better after any
type of procedure i perform i do procedures for lower eyelid rejuvenation every day and
my approach to lower eyelid blepharoplasty is based on strategies to minimize risk achieve
natural results and to facilitate recovery I perform a wide range of cosmetic eyelid surgeries
including specialized procedures that are not usually performed by general plastic surgeons
such as eyelid ptosis lacrimal gland prolapse and eyelid retraction surgery I’m also known for
performing surgical revision for complications of procedures performed by other surgeons
so what are the main concerns for people who come in for lower eyelid rejuvenation
it breaks down to three things one puffy under eye bags two under eye wrinkles and three
under eye dark circles the key to defining any solution is to first
accurately define the problem let’s start with the puffy under eye bags
as I mentioned earlier the puffy under eye bags are caused by prolapsed or herniated fat
in order to gain access to these fat compartments the conventional approach to surgery is to make
an incision below the eyelashes and to separate the skin and supporting muscles to get access to
these fat compartments this approach is called a transcutaneous blepharoplasty in my opinion this
approach of dissection results in a loss of the intrinsic strength of the eyelid structure which
is more strong intact than after the layers of the eyelid have been separated it’s like the
strength of a material like plywood which is made of thin layers of wood that are weak individually
but have strength when glued together loss of eyelid strength can cause the eyelid margin to sag
I prefer to perform lower eyelid fat modification from the inside of the eyelid using a technique
called transconjunctival blepharoplasty although this technique is considered to be
more technically advanced I make the effort in order to protect and preserve the integrity of
the tissue layers that would be separated from an external or transcutaneous blepharoplasty approach
the artifact modification is in performing sculpting and repositioning of the fat
such that you appear as if you never had bags under your eyes addressing under eye wrinkles
is where a lot of complications can occur and I’m consulted for this type of issue frequently
it’s common practice for surgeons to remove skin with the expectation that the wrinkles
will be smoother and that the skin will be tighter after this procedure unfortunately this particular
maneuver can contribute to rounding or retraction of the lower eyelids in some
situations the eyelid can even evert resulting in a condition called ectropion to make matters worse
not only does the cosmetic outcome not look good but the patient can also experience dry
eyes and other forms of eye irritation requiring ophthalmic management with eye drops and ointments
so how can this situation be avoided well there are two issues that should be addressed
the first is the assumption of skin excess the skin may appear to be excessive
if the supporting tendon called the lateral canthal tendon has become more lacks
this situation would be an indication for addressing the tendon as opposed to removing
skin if I see that the patient has lateral canthal tendon laxity I’ll perform a procedure called a
lateral tarsal strip to restore the stability of this very important support structure the second
issue is related to the appearance of wrinkled skin and it’s to differentiate skin quality from
skin quantity skin that appears to be redundant is more likely to benefit from procedures such as
fractional laser to induce collagen production and restore the skin surface with new layers of skin
that looks smoother skin removal can potentially cause a skin shortage that results in the eyelid
margin being pulled downward again resulting in eyelid ectropion or eyelid retraction in patients
with darker skin types who would not be candidates for laser I can stimulate collagen production with
a radiofrequency device like Pelleve I further enhance collagen stimulation with platelet-rich
plasma or PRP platelet-rich plasma is the concentration of wound healing and growth
factors found in the blood which are activated after an injury such as a simple cut another
benefit of PRP is the production of new blood vessels which can further improve skin quality
dark circles under the eyes are typically associated or caused by sun damage volume
loss or volume deficiency and a decrease in skin quality there are times when laser technology used
for wrinkles can also be used at the same time for discolorations under the eyes often seen with
sun damage for people with darker skin I often use PRP to address skin quality and skin discoloration
it appears that collagen stimulation and improved circulation to the skin
results in more refreshed and lighter appearance of under eye dark circles
to further develop the topic of all lower eyelid surgeries are not the same I look at bone volume
and projection below the eyes and the cheeks I’ve observed that prolapsed or herniated fat
often coexists with the deficiency in bone projection under the eyes and in the cheek bones
this deficiency in bone projection can be due to genetics or aging as well as
combination of the two it makes sense to reduce fat projection with surgery
and to enhance bone structure projection to create better balance and harmony in the past this bone
structure enhancement would have been achieved with surgical placement of facial implants
a newer technique called Structural Volumizing which was derived from
the principles of facial implant placement has made bone projection enhancement safe
predictable and without the downtime and risks of facial implant surgery so instead of implants I
use long lasting hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma which are
placed using a specific method this method allows for better projection and definition as opposed to
the pillowy and rounded appearance associated with the conventional approach to placement of fillers
as far as facilitating recovery I perform lower eyelid surgery using local anesthesia with
LITE IV sedation many of my colleagues prefer to perform eyelid surgery with general anesthesia
which is associated with side effects including nausea vomiting constipation
brain fog and prolonged recovery by contrast our patients are fully alert and comfortable after
surgery they generally return to work in about a week after surgery with minimal to no bruising
it should be abundantly clear at this point that lower eyelid surgery is not a standardized
procedure it’s important for you to have a clear understanding of your specific issues so you have
a clear strategy and minimize your risk of experiencing an undesirable outcome
I hope this information from my experience helped you
if you are interested in recommendations for your individual situation
you may contact us through our websites or call our offices to schedule a consultation thank you

What’s the best under eye filler? People often ask about the best filler for the under eye area to
treat hollowness eye bags discoloration and even wrinkles the answer to this question is predicated
on the assumption that filler is appropriate in all of these conditions I’ll discuss how I respond
to this question about the best under eye filler in my practice I’m Dr Amiya Prasad I’m a Diplomate
of the American Board of Cosmetic Surgery and Fellowship-trained oculofacial plastic and
reconstructive surgeon I’ve been in practice in New York City and Long Island for over 25 years
as a specialist in cosmetic eyelid surgery I’m known for helping people with issues like
hooded eyes drooping eyelids and under eye bags i also perform a lot of non-surgical procedures
such as fillers under the eyes for hollowness and to camouflage slight to moderately prominent
under eye bags I also use fillers under the eyes in combination with treatments like
platelet-rich plasma or PRP to help people with hollowness discoloration
and skin wrinkling so when people ask me which under eye filler gives the best results
the answer is not a specific brand more than one brand of filler can be used to enhance a hollow
area under the eyes it’s important to understand that a brand of filler doesn’t prevent issues like
overfilling or under filling nor can it prevent rare but dangerous complications like vascular
occlusion where the filler is injected into an artery resulting in tissue loss or even blindness
the results of filler treatment and the minimizing risk of complications is actually in the hands of
the doctor performing the procedure taking a step back it’s the doctor’s judgment that determines if
an under eye filler should be used even at all the indication for using fillers under the eyes
is to treat hollowness and to camouflage puffy bags which are minimally prominent
under eye hollowness is often due to a deficiency in bone projection and volume
in my opinion hyaluronic acid fillers are ideal for this area fillers can be placed in an area
called the tear trough enhancing the tear trough can help improve the appearance of hollow areas
as well as the transition zone or the transition area adjacent to under eye bags
now some practitioners who don’t perform surgery will try to use filler to treat all cases of eye
bags unfortunately when the under eye bags are too prominent fillers can actually make under eye bags
look even more puffy and even more prominent the type of filler material does matter when it comes
to safety my preferred material for patient safety and for predictable results is hyaluronic acid
hyaluronic acid is a naturally occurring substance in the body found in the skin and the joints
this means that this material is generally well tolerated without any kind of foreign body
reaction the hyaluronic acid fillers I use are in the Restylane and Juvederm line of products many
people want longer term benefits so they look to have permanent or semi-permanent fillers I
strongly discourage this choice unlike hyaluronic acid fillers permanent and semi-permanent fillers
actually require surgery for removal should there be a problem hyaluronic acid fillers on the other
hand can be dissolved with the injectable enzyme hyaluronidase i also don’t recommend fat grafting
for this area in spite of the best of intentions fat grafting is unpredictable and can result in
lumps and irregularities which actually may be too difficult to remove without compromising eyelid
support further as an oculoplastic surgeon I can’t overstate the importance of safety around the eyes
there have been incidents of vascular occlusion resulting in blindness after filler injection in
this area as far as short-term risk is concerned bruising is probably the most common issue after
under eye filler injection i have a lot of experience with reconstructive surgery
such as fracture repair and the placement of cosmetic implants like tear trough implants
i use this experience to help me place fillers using blunt tipped cannulas in this area
thereby avoiding any bruising in the majority of my patients many of our patients actually
schedule for filler procedures such as under eye or tear trough filler placement
through our same day scheduling system this means that they come during a break in their work day
such as lunch to have a procedure and then go right back to work I see patients typically after
two weeks to see how the material has settled and if any enhancement would be appropriate
so when considering under eye filler treatment the importance of safety as I said earlier
can’t be overstated an experienced physician who is prepared to address any complication in
a timely manner is in my opinion the best option when risk is factored into your decision marketing
influences consumers to choose product when in actuality the practitioner choice you make is far
more important I hope you found this information helpful and thank you for your question