Why surgery is generally not advised for under eye wrinkles

Can I have surgery for under eye wrinkles? Many people come into my office
and show me how pulling the skin under their eyes outward results in the skin
looking smoother they ask can you do this doctor I showed them with a mirror
how the areas around their eyes become distorted and the level of tension that
they’re using with their fingers cannot be sustained long-term with surgery
nonetheless surgery to address under eye wrinkles is still very commonly
performed and the complications of this approach can be quite significant I’ll
discuss how I address under eye wrinkles 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 as a cosmetic eyelid surgery specialist I regularly perform
all types of cosmetic eyelid surgeries for under eye bags
hooded eyelids drooping eyelids or eyelid ptosis as well as revision work
to correct complications from other surgeons such as eyelid skin removal to
treat wrinkles causing rounding of the eyes pulling down to the lower eyelids
or lower eyelid retraction and even a COPI on where the inside of the lower
eyelid is exposed outward a common misconception is that wrinkles under the
eyes are caused by excess skin this perception is reinforced by people
pulling on the skin and seeing how the skin doesn’t snap back into place so
quickly this is a reflection of decrease in skin quality not an increase in skin
quantity the eyelid skin is the thinnest skin in the body at about 1/2 of
meter a simple concept remember is that this very thin skin has limited
tolerance for overly aggressive treatment in addition to the skin
quality the appearance of the eyelid skin is also affected by the tension of
the lower eyelid the lower eyelid is like a suspension bridge and a
particularly important point of support is a structure called the lateral
canthal tendon if for any reason there is laxity of this tendon the eyelid
margin can sag and the skin can appear loose and redundant laxity the lateral
canthal tendon is typically seen with aging however I have seen it often in
people who have seasonal allergies in order to improve the appearance of the
skin it’s been well established from using chemical peels and lasers that
removal or ablation of the epidermis and the upper part of the dermis can result
in smoother looking skin thermal energy delivered to the dermis
results in the production of collagen which can create an improved foundation
for the epidermis new epidermis after chemical peel or laser appears smoother
after treatment in my practice I’ve used ablative CO2 and erbium laser as well
as fractionated CO2 and erbium laser the challenge has always been to be able to
perform a procedure for under eye wrinkles without the typical one-week
downtime with this in mind I’ve been using a long pulsed erbium fractionated
laser which we refer to as the Smooth Eye procedure this procedure is
performed in my exam room with the only topical anesthetic and takes only a few
minutes to perform the patient has no downtime and comes in for about three
sessions each session is about one month apart if a patient has a crepey very
thin quality to the eyelid skin I often use PRP to help the skin be able to
tolerate any laser procedure better I feel that if this thin eyelid skin is
weak it should be prepared in order to respond effectively to any laser
procedure I refer to this as skin rehab if a patient has darker skin is not a
candidate for laser I use radiofrequency technology to induce collagen remodeling
instead of laser many times people with thin lower eyelid skin also have
wrinkles around the eyes like crow’s feet lines these lines get deeper with
expression so these dynamic wrinkles can be reduced with regular injections of
botulinum toxin such as Botox or Dysport topical skincare such as the use of
retinols and moisturizers with some active ingredients can be beneficial for
ongoing maintenance this appearance and behavior of lower eyelid skin is often
seen with other changes such as the prolapse of lower eyelid fat pockets in
order to address puffy under eye bags a surgical procedure called lower eyelid
blepharoplasty is indicated the most common approach to addressing under-eye
bags surgery is a procedure called
transcutaneous blepharoplasty during a transcutaneous blepharoplasty an
incision is made just below the eyelashes and the skin and muscle are
elevated separated so the fat causing eye bags can be addressed
typically eyelid skin is trimmed and sutured in a effort to tighten the skin
the problems with transcutaneous blepharoplasty procedure include skin
shortage due to excess skin removal as well as compromising of the lower eyelid
support due to a separation of the tissue layers which previously were
stronger as a unified structure lower eyelid skin is part of the layered
structured responsible for lower eyelid support just under the skin is your
bycula oculi muscle which acts like a hammock and is attached to the bone
biased structure called the lateral canthal
tendon inherently there is a compromise of these support structures when the fat
pockets are accessed through an external incision patients who had the surgery
come to see me every week with lower eyelid rounding retraction and even
ectropion because of skin shortage after skin removal for these conditions I
perform advanced reconstructive procedures including skin and tissue
grafts to restore this compromised anatomy in my practice for under-eye
bags I perform a procedure called a transconjunctival blepharoplasty I
sculpt the fat pockets responsible for the eye bags from the inside of the
eyelid so no external incision is needed this is considered a more advanced and
specialized procedure by performing transconjunctival blepharoplasty I’m
preserving the anatomic structures that support the lower eyelid for under eye
wrinkles I use fractional co2 and erbium laser with PRP this combination has
proven to be safe and effective in improving the appearance of under eye
wrinkles without skin removal again I’m focusing on improving the skin quality
I’ve observed particularly in people who lack cheek projection that the eyelid
skin appears to be redundant when it’s simply sagging from lack of support or
projection instead of removing skin I restore volume in the cheek with
long-lasting hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm
Voluma these fillers will not weigh the skin down since I placed them at the
bone level similar to the way I would place a facial implant this is called
Structural Volumizing and it’s very effective in restoring balance between
the cheeks and the eyes I performed transconjunctival blepharoplasty and
most other cosmetic surgery in my office under local anesthesia with
minimal IV or LITE sedation my patients recover quickly and return to work in
about a week this is opposed to general anesthesia where recovery from the
effects of anesthesia alone can be unpleasant and physically draining so if
you’re concerned about wrinkled skin under your eyes understanding that skin
quality is more relevant to your treatment strategy than skin quantity
it’s also important to understand the other anatomic factors which can be
contributing to the skin under your eyes appearing to be redundant I cannot
stress enough the importance of recognizing the delicate structure of
the eyelid skin to avoid overly aggressive procedures which can make the
skin look worse and even compromise the integrity of the lower eyelid although
you can get away with a limited skin removal such as a skin print procedure
the underlying qualitative issues are more important in my experience doctors
who advise eyelid skin removal may believe they’re doing their best to help
you you need to be sure that you’re able to retain the natural shape of your
lower eyelids after that type of procedure is performed I hope you found
this information helpful thank you for your question

Hair Transplants Are Not Advised for Most Female Pattern Hair Loss Cases

When can women have a hair transplant? Hair transplants are often what people
think of first when they think of hair restoration many women with female
pattern hair loss who consider hair transplant are often not candidates for
hair transplant surgery a diffuse pattern of hair thinning is
characteristic of female pattern hair loss since hair transplantation requires
making multiple small incisions into the scalp there is a high risk of permanent
loss of significant amounts of existing hair
for women with diffuse hair thinning this is in contrast to male pattern hair
loss where hair is transplanted to bald non hair bearing skin there are some
situations where a hair transplant can be performed for women 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’ve been performing hair
transplant surgery throughout my career I’m also the founder of trichostem hair
regeneration centers which is a non-surgical treatment for male and
female pattern hair loss which I developed from technology originally
used to improve the outcomes and results of hair transplant surgery female
pattern hair loss telogen effluvium and hormonal changes such as pregnancy and
childbirth are the most common causes and factors affecting hair loss in women
in a typical female pattern hair loss the hair thins diffusely throughout the
scalp female pattern hair loss is the most common cause of hair loss in women
it actually affects about 30 percent of women under 50 and about 50% of women
over 50 traditionally the only treatments available for female pattern
hair loss were minoxidil and spironolactone
minoxidil allow for a delay in the natural hair shedding cycle and extends
the hair growth cycle so more hair is on the scalp I find that most of my female
pattern hair loss patients do not see any benefit and abandon minoxidil use
the drug spironolactone is often prescribed as a testosterone blocker and
has limited to no benefit as reported to me by patients who were placed on this
drug before coming to see me we have been able to treat female pattern hair
loss successfully since 2011 with our TrichoStem Hair Regeneration treatment
this is a non-surgical injection treatment so the collateral loss
associated with hair transplant is not an issue the treatment is comprised of
primarily a platelet-rich plasma a concentration of healing and growth
factors found in your own blood and a combination with extracellular matrix
produced by the company a cell extracellular matrix is an advanced
wound healing material first used in regenerative medicine and surgery for
female pattern hair loss we have achieved in over ninety nine percent
success rate with this treatment with patients showing visible improvement and
hair coverage and density by the thickening of thinning hair and the
stimulation of growth from hair follicles that were previously not
growing the benefits are seen for three to five years with the only one
injection treatment some patients benefit from a second treatment we call
the booster at 18 months or so after the first treatment there are some
situations where hair transplant can be done for women severe or advanced
pattern hair loss where the hair part has widened significantly and resulted
in smooth almost bald areas for more than five years these are areas
that can be transplanted transplantation would be limited to areas of mostly
smooth scalp with little to no nearby native hair to minimize collateral loss
another condition is traction alopecia where constant tension on the hair
follicles can cause permanent hair loss traction alopecia is common in people
wearing consistently tight hairstyles like braids or tight ponytails I’ve had
patients see me who are older who tried to tighten their facial and forehead
skin by pulling their hair tightly this led to a lot of hair loss a transplant
is the only way to restore hair where there are no hair follicles the use of
chemicals like hair relaxers can result in permanent loss of hair follicles in
some cases where the hair has thinned due to chemical use we have been able to
make a significant improvement for women with TrichoStem Hair Regeneration
treatment another procedure is hairline lowering hairline lowering is primarily
for women who feel their hairline it’s too high or too much of their forehead
is exposed due to a lack of hair hairline lowering is approached like any
hair transplant with adjustments for the area of the forehead as is appropriate
in hairline lowering procedures patients should expect to have more than one
procedure to achieve a natural-looking density there are fewer options to treat
pattern loss for women were compared to men for example the drug finasteride can
be effective for men but does not have any role in female pattern hair loss
management the work we did to develop trichostem hair regeneration has
successfully helped women the majority of whom would not be
handed it for hair transplant surgery address their hair loss without surgery
I hope you found this information helpful thank you for your question

Minimizing and managing the risks of cosmetic upper eyelid surgery

What are the risks of cosmetic upper eyelid surgery? Cosmetic upper eyelid
surgery can be a highly effective way to improve the appearance of hooded eyes
and drooping eyelids specialized procedures such as Asian eyelid surgery
can be done so you appear as if you were born with a natural eyelid crease that
reveals the beautiful shape of your eyes successfully performed cosmetic upper
eyelid surgery doesn’t draw attention because it looks natural and fits with
the individuals facial characteristics what we do notice almost immediately are
the eyes of people who had either surgery and don’t look like themselves
typically they look tired tight and even surprised eye contact is the foundation
of social interaction so having eyes that don’t look natural can have a
significant impact on so many aspects of your life
cosmetic upper eyelid surgery is a complex art in order to achieve
attractive and natural-looking eyes it’s also a science requiring scientific
precision to the point that the difference between great results and
complications can be measured in millimeters I’ll discuss the risks
involved in cosmetic upper eyelid surgery and what I do to plan and
perform procedures with a high rate of successful outcomes
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 routinely perform
cosmetic eyelid procedures every day in my practice such as lower eyelid surgery
for under-eye bags upper eyelid blepharoplasty
for hooded eyelids double eyelid surgery to create an eyelid crease as well as
specialized oculoplastic procedures such as eyelid ptosis surgery I also
specialize in revision eyelid surgery to help people who’ve had complications
from surgery originally performed by other doctors a significant risk and
concern for patients I see in consultation for upper eyelid
blepharoplasty is excessive skin removal such that the person has difficulty with
eye closure one of the most common indications for upper eyelid surgery is
called dermatochalasis dermatochalasis is a condition where the upper eyelid
skin stretches and thins resulting in redundant folds over the eyes and
creating a hooded appearance I find that the shape created by this hooding
essentially defines the shape of the eyes and makes the eyes look like you’re
tired or angry to treat the hooded appearance eyelid skin needs to be
removed a first impression to how to address excess skin may be to just pinch
the skin and remove what’s being paged it’s actually not so straightforward the
upper eyelid needs to move with ease during blinking and in order to do
properly distribute the tear film over the eyes this means you need to leave
behind enough skin to allow for this action to take place in addition the
skin below the brow may have descended because of the eyebrows being in a lower
position what is referred to as eyebrow ptosis during the skin pinching process
there may be recruitment of skin below the eyebrow which can cause downward
displacement of the eyebrow and keep the eyes looking like they’re still hooded
further the extent of skin removal can actually drag
the eyebrow closer to the eyelid which is not a good look the skin elasticity
is critical when determining the amount of skin that’s needed to be removed for
eyelid surgery if the skin has limited stretch less concedes to removed if the
skin is very elastic more skin needs to be removed when too much skin is removed
the eyelid function can be compromised the patients with skin shortage after
upper eyelid blepharoplasty will often complain of their eye or eyes looking to
open and feeling discomfort with blinking they also report that their
eyes don’t close even when they’re sleeping it’s common for these patients
to need dry eye therapies such as the frequent application of artificial tears
and lubricating gel or ointment to be used at night for patients who come to
me in this situation I typically have to perform skin graft surgery in order to
restore the skin needed for proper eye function so what do I do to minimize the
risk of skin shortage after surgery well I factor in skin elasticity eyebrow
position and I help when I draw my design I spend a lot of time taking
measurements the art is also in the placement of the eyelid crease as well
as where the skin removal should begin and end relative to the inner and outer
corners of the eyes I also provide some estimation as to what the patient’s
upper eyelids will look like by using an instrument or a Q-tip to displace the
skin inward to reveal a more defined eyelid crease cosmetic upper eyelid
surgery is not just about redundant skin but also about fat located in two
distinct areas the first is called orbital fat
there are two fat compartments and the lacrimal gland within the space between
the bone and the muscle that lifts the eyelid called the levator muscle the
volume and position of the prolapsed fat as well as the lacrimal gland have
significant effects on the appearance of the upper eyelid this is why upper
eyelid blepharoplasty is not just a skin removal procedure as the surgeon you
have to be able to anticipate the appearance that will result when you are
sculpting the prolapsed fat in the upper eyelid if too much fat is removed during
surgery it can cause the upper eyelids to look hollow and even droopy the
second area which is relevant to the appearance of the upper eyelids is fat
and soft tissue located below the outer aspects of the eyebrow called the sub
bra fat I focus on this area particularly if the outer part of the
upper eyelids look very heavily hooded the result is a more open space on the
outer aspect of the upper eyelid revealing the true shape of the eyes I
often see patients who had surgery elsewhere and are concerned about having
had too much fat removed they’re looking for a solution to restore some fullness
over their eyes there are several surgical options which
I have performed throughout my career including fat grafting and dermis fat
graft surgery the challenge is that in this area particularly after surgery
there can be a limited blood supply limited blood supply could compromise
the viability of a tissue graft I have found that the placement of hyaluronic
acid filler to restore fullness has been highly reliable in cheating improvement
which can be appreciated immediately the technique I use allows me to place
volume with great precision and my patients don’t have to have a
recovery time as a would after surgery another common issue I see is not
addressing the presence of eyelid ptosis eyelid ptosis occurs when the margin of
the eyelid is lower than it should be the cause of eyelid ptosis is generally
related to the muscle which lifts the eyelid called the levator muscle like
the word elevator without the letter e in the beginning it’s been my
observation that general plastic surgeons choose not to address eyelid
ptosis and if essentially hope that removal of skin and fat will be enough
for a good result as a cosmetic oculofacial plastic surgeon I couldn’t
disagree more with this had in the sand approach when the upper eyelid is too
low you look tired or sleepy so when ptosis is not recognized and
addressed the eyelids will still look droopy after the surgeries performed a
basic fact and point of differentiation between the residency training of
general plastic surgeons in comparison to fellowship training of oculofacial
plastic surgeons is as follows a general plastic surgeon during a residency in a
typical Hospital will have limited exposure to eyelid surgery in comparison
to their exposure to breast hand and other body reconstructive procedures
since residency programs receive support from Medicare it’s unlikely for a
general plastic surgeon to have significant training in cosmetic eyelid
surgery or specialty training in cosmetic oculoplastic surgery otherwise
the taxpayer would be paying for elective cosmetic procedures which is
not supposed to happen cosmetic surgery in oculoplastic surgery training are
examples of fellowship training these are training programs for doctors
after completing a residency as an oculofacial plastic surgeon I first
trained in ophthalmology or eye surgery I then received specialized training
through fellowship in order to learn specialized procedures such as ptosis
surgery if a patient has ptosis and is going to have an upper eyelid
blepharoplasty I can operate on the levator muscle as well as the muscle
behind the upper eyelid called Mueller’s muscle these are not procedures
typically performed by general Plastic Surgeons brighter looking eyes after
ptosis surgery with blepharoplasty can be very gratifying for the patient there
are always risks to any surgery but risks can be reduced through the
experience and expertise of the operating surgeon eyelid surgery is one
of the procedures you don’t want to choose based on cost or by assuming that
all eyelid surgery procedures are the same as business and marketing and
elective healthcare services become increasingly commoditized for example
think about ads for discounted liposuction you as the patient have to
be your own advocate eyelid surgery is unique in that the results of a cosmetic
procedure not only affects your appearance but also affects your vision
I hope you found this information helpful thank you for your question

Why Skin Treatments Can’t Treat Eye Bags

Can I treat eye bags with lasers or prp instead of surgery? People often ask about
treating their puffy under eye bags non-surgically with skin rejuvenation treatments like creams
platelet-rich plasma or PRP lasers or thermal devices like radiofrequency and ultrasound
devices I’ll discuss why non-surgical treatments can be effective for lower eyelid skin issues like
wrinkles or discolorations and how you can address under eye bags with a minimally invasive
approach I’m Dr Amiya Prasad I’m a diplomate of the American Board of Cosmetic Surgery
and I’m a Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice
for over 25 years in New York City and Long Island I treat puffy under eye bags every day in my
practice as well as other lower eyelid skin issues such as wrinkles and dark circles under the eyes
I perform a wide range of eyelid procedures including revision
eyelid surgery for complications from surgery performed by other doctors
it’s important to first establish the basis for the presence of puffy under eye bags
as opposed to fluid related puffiness associated with allergies and dietary salt intake the type
of eye bags that I treat in my practice are the types that are visible all the time
eye bags that are always visible is caused by lower eyelid fat prolapse
this is a situation where the fat that’s normally under your eyes has prolapsed or herniated
forward resulting in under eye bags since the skin itself is not responsible for lower eyelid fat
prolapse it stands to reason that skin treatments can’t actually treat under eye bags under eye bags
often coexist with under eye hollowness so an injectable filler can be placed in the tear trough
area to camouflage the prominence of herniated fat but there’s a limit in how much under eye filler
can be used and beyond a certain level of prominence of lower eyelid fat prolapse
any placement of volume in this area can actually make the eye bags
appear even larger and more prominent the most definitive approach to treating eye bags
is to sculpt and reduce the fat with a procedure called cosmetic lower eyelid blepharoplasty
if you are someone who has reservations when hearing the word surgery you’ll appreciate why
i characterized my approach to under eye bags as being minimally invasive there are two ways
to approach lower eyelid surgery the first I’ll describe is called a transcutaneous blepharoplasty
this is the more conventional approach where the fat pockets are accessed through an incision
in the lower eyelid skin below the eyelashes in order to access the lower eyelid fat compartments
the muscles supporting the lower eyelid have to be released and separated oftentimes
skin is removed for the purpose of addressing wrinkling under the eyes now in my opinion
this type of surgery is more invasive and more likely to result in complications such as
rounding or lower eyelid retraction due to weakening of the supporting structures responsible
for the natural shape of the eye in an effort to avoid this problem a surgeon performing this type
of procedure may actually attempt to tighten the lower eyelid thereby making the eye appear
smaller in width this appearance of changing or losing the characteristic shape of the eye
is often the most significant objection someone would have for undergoing lower eyelid surgery
in my practice I routinely perform a lower eyelid blepharoplasty through a
transconjunctival approach this means that I don’t make an external incision but rather approach the
under eye bags from the inside of the eyelids this is considered a more advanced technique
which allows me to preserve the integrity of the structures which can be compromised
with a transcutaneous or external approach
at the completion of this procedure the anatomy simply appears as if you never had under eye bags
my patients appreciate retaining their natural eye shape and being free of their under eye bags
naturally the question arises about what to do about the wrinkles under the eyes
well wrinkles in the lower eyelids are typically caused by diminished skin quality not
an excess of skin quantity so removing skin is not needed to treat wrinkles in the lower eyelids
depending on a person’s skin type I will routinely use a fractional co2 laser or radiofrequency
device to improve the appearance of fine lines and wrinkles under the eyes I further enhance
the effectiveness of these treatments by using PRP or platelet-rich plasma my patients after this
type of procedure can usually return to work in one week or less with minimal swelling or bruising
ironically patients have come to see me who have tried various non-surgical procedures such as
injectables under their eyes and experienced weeks of bruising and swelling which were far greater
than my patients typically experience with my transconjunctival approach to treating under
eye bags I perform these procedures in my office operating facilities under local anesthesia with
LITE IV sedation thereby avoiding the risks and complications associated with general anesthesia
while skin treatments can’t directly treat herniated fat
responsible for under eye bags they can be used to optimize the results of a more definitive
surgical procedure such as transconjunctival blepharoplasty 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

Surgically Creating an Eyelid Crease / Double Eyelid Fold

How is an eyelid crease created? It’s generally  understood that about half of people of Asian
descent do not have an eyelid crease so  common question I hear during consultation
is about how they can get an eyelid crease or a  double eyelid fold not having a double eyelid foam
can make the eyes look smaller the eyelashes can  be barely visible as well as make it challenging
to apply eye shadow now these patients are  motivated to make their eyes appear bigger
and brighter and I’ll discuss how I help people  who want to have an eyelid crease 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 new york city and long island for over 25 years
I’m well known for my work for both primary  and revision cosmetic eyelid surgeries such as
treating under eye bags and hooded eyes as well  as advanced oculoplastic procedures like eyelid
ptosis surgery I’m also known for eyelid surgery  performed for specific ethnicities such as keloid
prone darker skin types and Asian double eyelid  surgery an eyelid crease is formed through a
natural connection between the muscle that lifts  the upper eyelid called the levator muscle and the
overlying eyelid skin the point where the this  connection is made is where the eyelid folds
when the eyes are open thereby forming the  eyelid crease people without this skin to muscle
connection don’t have a defined crease they may  have a weak skin to muscle connection resulting in
shallower crease or multiple shallow creases a  weak connection can also be seen as a crease that
only forms some of the time but it’s typically  not very deep if someone doesn’t have a natural
eyelid crease it can be created with surgery known  as Asian eyelid surgery Asian blepharoplasty or
double eyelid surgery when I perform double eyelid  surgery I create skin to muscle connection using
sutures during consultation i show my patients  how their creases would look like by pushing
the upper eyelid skin back using a Q-tip or an  instrument this reveals what a natural crease
would have looked like if someone were born with  it and serves as an approximation of how they will
look after surgery an individual’s facial anatomy  determines the shape of the crease whether it runs
parallel or tapers towards the inner corner of  the eye while non-surgical methods like taping
or gluing the eyelids can temporarily create the  appearance of an eyelid fold surgery is really the
only way to create a stable defined long-lasting  eyelid crease the adhesive used to do and double
eyelid temporarily can irritate the skin and the  constant removal of tape or glue can even stretch
the eyelid skin and even go so far as the muscle  that lifts the eyelid which may require more
extensive and expensive surgery than the usual  double eyelid surgery which I routinely perform
there are two main categories for double  eyelid surgery non-incisional and incisional
generally speaking the anatomy and the age  of the patient determines which technique
is most appropriate for that individual  excessive skin as well as prolapsed fat can
interfere with the formation of a defined crease  that would reveal the natural shape of the eye
by performing incisional asian eyelid  surgery i can precisely address these issues
and create the connection between the skin and  levator muscle to form the desired eyelid crease
if you don’t need to have excess skin or fat  removed I select the non-incisional technique
to create an eyelid crease when I  perform a so-called non-incisional
Asian blepharoplasty I’m actually creating some  small openings through which I can place sutures
to make a connection between  the skin and the levator muscle
generally the non-incisional technique is  indicated for younger patients as well as
older patients who have had previous eyelid  surgery and no longer have any excess skin
I routinely perform these procedures under local  anesthesia and LITE IV sedation in my office
operating facilities my patients appreciate not  having to be under general anesthesia and thereby
avoiding the associated risks and complications  of general anesthesia our patients typically
return to work in one week or less with minimal  swelling depending on the type of procedure they
have aftercare consists of the application of cold  compresses and antibiotic ointment for a few days
so with a better understanding of how  eyelid crease surgery is performed
you can now learn more through a proper  consultation with an experienced surgeon
with expertise in Asian double eyelid surgery  a natural double eyelid can reveal the
true shape of the eyes while maintaining the  characteristics specific to your ethnic background
I hope you found this information  helpful thank you for your question

Improving Hair Coverage After a Hair Transplant

I had a hair transplant but I’m not happy with the results what else can I do?
Surgical hair transplants are marketed to be the perfect solution for
male pattern hair loss and in select situations for female pattern hair loss
hair transplant surgery is very time and labor intensive with a significant
financial cost unlike cosmetic surgical procedures such as facelifts which
usually requires formalized training such as a Fellowship through the
American Board of Cosmetic Surgery hair transplant surgery is offered by a wide
range of physicians from different medical specialties without any
residency requirement I’ll discuss how I help people who come to me who have had
hair transplants performed elsewhere who present with a range of issues including
dissatisfaction with their results 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 performed hair transplant surgery throughout my career I’m also
the founder of TrichoStem Hair Regeneration Centers this non-surgical
treatment for male and female pattern hair loss has been highly sought after
with patients coming to us from around the world
I developed trichostem hair regeneration based on wound healing technology are
used to improve the outcomes of hair transplant surgery a common complaint
about hair transplant surgery is the appearance of low hair density often
described as looking unnatural factoring for different ethnicities a rule of
thumb is that normal hair density ranges from about 50 to 100 hairs per square
centimeter of scalp unfortunately hair transplant surgery
has limitations technically and in the ability of the scalp to heal
effectively to support the growth of hair grafts this leaves hair transplant
patients with hair spaced much further apart than is seen with natural hair
density so hair transplant results can look somewhat sparse a commonly
recommended option is to try and perform a second or a third hair transplant
operation while most ethical hair transplant surgeons will avoid
performing hair transplant on men with pattern hair loss in their 20s I see a
fair number of patients who had one or even two transplants before the age of
30 the problem is that many men with pattern hair loss in their 20s are
losing hair very fast due to genetics and relatively high dihydrotestosterone
or DHT-sensitivity the transplant surgery cannot keep up with the rate and
extent of the ongoing hair loss in addition about 80% of these patients
contemporaries have a lot of hair so they aspire to look like other men in
their 20s this cannot be achieved with hair transplant many men who start
having hair transplant surgery dis young try to keep up with their contemporaries
they undergo multiple transplants by the time they reach their 30s they
experience rapid and progressive thinning and are left with very little
hair which was transplanted the amount of hair available for transplant is not
close to the amount of hair that’s lost the peak hair count in the teen years
number in about 100,000 hairs generally when someone first notices hair loss
they’ve already lost about half their hair as hair loss advances that
percentage becomes much higher the number of grafts available in the donor
area or the permanent zone located in the back and sides of
the scalp where the transplants are harvested from ranges from 1,500 to
4,000 grafts each graft contains about 1 to 3 hairs simply put a hair transplant
cannot replace all the hair that is lost so transplant surgery cannot cover the
whole scalp transplant surgery is typically focused on improving the
frontal hairline to frame the face both temporary and permanent hair loss can be
actually caused by hair transplant surgery the trauma of performing
transplant surgery can actually cause collateral loss of existing native hair
this occurs when hair is transplanted close to native hair follicles where a
combination of variables including direct injury vascular compromise and
inflammation result in loss of these existing native hairs hair transplant
surgeons often rationalize that the native hair was already thinning and was
going to be lost eventually if you are dissatisfied with your results after
some time has transpired after your hair transplant surgery it could be due to
not managing the progression of your hair loss after your surgery hair
transplant do not stop progressive hair loss native
hair continues to thin after a transplant leaving behind the
genetically resistant of thinning hairs that were transplanted this often
results in a pluggy look where isolated grafted hair continues to grow but
native hair has gone in our practice starting around 2011 I observed that
native thinning hair became thicker when we used a combination of PRP which
stands for platelet-rich plasma and an advanced wound healing material called
extracellular matrix made by the company ACell which we use to help improve the
outcomes of hair transplant surgery I recognize that most men who come for
consultation for hair transplant are men whose hair is thinning not bald
since thinning hair is already present at a naturally higher density than what
can be achieved with hair transplant I came up with the idea that there was a
potential to help my patients with thinning hair non-surgically
this concept became reality as I developed customized formulations and
methods of delivery and evaluated the results for men and women of all ages
ethnicities and variable levels of aggressiveness
and of course extent of hair loss I made observations and developed a
classification system which helps me optimize treatment lands that are based
on gender age age of onset of hair loss degree of hair loss and rate of hair
loss this became trichostem hair regeneration which was so consistently
effective that I built a free-standing Center specifically for this new
approach to hair loss in Northern Virginia TrichoStem Hair Regeneration
addresses thinning hair in men and women by reactivating hair which was not
growing due to a prolonged resting or telogen phase and by thickening hair
that was thinning before treatment we treat hundreds of patients a year from
around the world non surgically with results that in many situations provides
better scalp coverage than a hair transplant or even to hair transplant
surgeries we routinely see people who’ve had hair transplant prior to coming for
consultation there are certain specific situations we see regularly hair
transplant which was performed within three to six months of consultation hair
transplant which was performed within the past five years and hair has
continued to thin several hair transplants were performed prior to
consultation hair transplant was performed more than once and the patient
is considering having another hair transplant when a
patient comes in within three to six months after hair transplant there is a
potential opportunity to improve the outcome of the hair transplant surgery
particularly at the two to four month time frame this is based on the
principles of optimizing tissue and graft healing to maximize the growth of
the transplanted hairs as well as activate existing native hairs to grow
in thicker ultimately working in synergy with the transplant to maximize scalp
coverage I do look at each situation individually since a hair transplant
outcome can be considerably lower than anticipated even when everything goes as
planned I also advise some patients to wait until the hair transplant is fully
healed and their doctor determines that they have reached the point of maximal
growth which is around one year to 18 months after hair transplant many of our
patients who are several years out after hair transplant come because they are
looking for options to manage their hair loss which naturally continued after
their hair transplant surgery as the native hair is thin and disappear the
transplanted hair becomes exposed and looks somewhat more obviously
transplanted or as is often described pluggy often times these patients have
not followed up with the hair transplant doctor for any further management I
discuss the options they have for medical and non-surgical management as
well as the feasibility of additional surgical hair transplantation it’s
important to understand that hair loss is progressive and not cured but managed
my approach is to assess the volume of native thinning hair which are in the
same area as the transplanted hairs as well as the area where there aren’t any
or just a few transplanted hairs with TrichoStem Hair Regeneration I can
potentially improve the coverage without surgery in these areas I also
discussed from male pattern hair loss patients the role of DHT-blockers such
as finasteride to maximize the longevity of the hair growth cycles which allows
for longer-lasting scalp coverage generally I find that people who’ve had
one or more hair transplant surgeries are eager to do a less involved
procedure to see how much improvement they can achieve in situations where
hair loss has significantly advanced and hair transplantation is in the plans
particularly in the frontal hairline area I offer a comparable strategy as
previously mentioned in addition I find that many of these patients report that
their graft survival was considerably less than they had anticipated based on
the number of grafts transplanted this can occur even when the procedures
performed successfully in my practice as a specialist in revision eyelid surgery
and facial cosmetic procedures I see people where their tissue has been
scarred or been compromised by the blood supply after undergoing multiple
revision surgeries in order to ensure optimal healing when I perform surgery
for these patients I use PRP as well as PRP with a cell to enhance the quality
of the traumatized tissue and scar tissue to improve the probability of a
successful surgical procedure I suggest the same for someone who’s had
low grass survival after one or two hair transplants essentially I’m trying to
improve the scalp tissue quality after the skin has been traumatized and
potentially compromised by the blood supply and scarring this concept has
been successfully applied to patients who’ve had multiple hair transplant
surgeries very often when the patient has had more than three transplant
procedures the transplanted hair can grow with significant variability in
appearance one patient who we recently treated was
cutting his hair short to hide the situation after he underwent trichostem
hair regeneration he felt that he could confidently allow his hair to grow
longer and he appreciates how all his transplanted hair looks and feels it’s
important to remember that hair loss is not cured but managed I spent a
considerable part of my career performing hair transplant surgery as
the only option to improve scalp coverage by placing thicker hairs in
areas where hair was thinning or was completely gone after developing
TrichoStem Hair Regeneration since 2011 I’ve actually helped men and women with
thinning hair significantly improved their appearance for periods of 3 to 5
years or more without surgery the marketing of hair transplant surgery
does not communicate anything about the limitations and potential for sub
optimal outcomes nor is there any mention of managing hair loss after
transplantation is performed I’ve been able to apply the technology behind
TrichoStem Hair Regeneration to help people who’ve undergone one or more
transplants optimally manage the ongoing challenge of maximizing scalp coverage
for as long as is genetically possible I hope you found this information helpful
thank you for your question

Why Lasers Cannot Replace Surgical Lifting

Can lasers lift and tighten skin? Advertising messages from device
manufacturers and individual medical practices have implied or outright made
claims that facelifts can be done non surgically using lasers and other
heating devices like high-frequency ultrasound heat generating what thermal
energy devices do have a role in cosmetic medicine it’s important to
understand the limitations of these technologies and understand where they
stand in comparison to any other types of procedures it’s also important to
recognize the potential detrimental effects of excessive heat on the skin
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 performed a full
range of surgical facelifts from many lifts and deep plane facelift I also own
several lasers and thermal energy delivery devices including fractional
CO2 laser long pulsed 1064 YAG laser erbium lasers W-switch laser and Pelleve
radiofrequency I also perform other non-surgical facial rejuvenation
treatments like the use of PRP or platelet-rich plasma to improve skin
quality as well as fillers and implants to improve facial volume in areas such
as the lips chin cheeks and jaw line associated with genetics and facial
aging starting off with what lasers and other thermal energy devices can do they
can tighten and improve the skin several ways the heat of thermal devices can
make the skin contract so they can help improve issues like wrinkles thermal
devices work on a controlled injury model where heating the skin to specific
temperatures will induce the body to produce
halogen as a repair response to injury collagen is the protein that gives skin
its strength and its foundation and contributes to the appearance of a
youthful smooth looking skin with partial ablation also known as
fractionated laser treatment the top layers of skin can be partially removed
to allow for new fresh layer of epidermis to come in lasers such as a
q-switch laser can tone the skin and stimulate collagen without any ablation
or downtime in our practice we use a long pulsed 1064 YAG laser which can
elevate the skin temperature to tighten the skin as well as to induce fat
reduction on the face and body as effective as these devices can
potentially be they cannot lift the skin like a facelift the aggressive marketing
using celebrities to promote non-surgical so-called facelift using
devices as their beauty secret in my opinion is deceptive and potentially
harmful people come in for laser or thermal treatments wanting the same
appearance as a celebrity endorser or the results of a facelift without
undergoing surgery just because a celebrity claims to use a particular
device it doesn’t mean their appearance that the result of only using the
promoted device it’s more likely the celebrity also had facelift as well as
eyelid surgery and cosmetic fillers and a whole other bunch of stuff when people
want results from a thermal device that a celebrity endorser actually got from
multiple unrelated procedures including surgical lifting there is a significant
potential risk to the skins health if a patient receives more aggressive
treatment to lift their skin they may be literally cooking the fat layers beneath
the skin which is very important for a glow of youthful volume misleading
consumers to think a non-surgical lifting as possible can put doctors in a
compromising position to do more aggressive
treatments and potentially compromise safety or do less aggressive treatments
and their patients will end up being dissatisfied having achieved more
realistic outcomes another reason why lifting with thermal devices is not
effective is that sagging goes on beyond just the skin and affects the muscle and
soft tissue layers below the skin the skin throughout most of the body is only
two millimeters in thickness but muscle and soft tissue also sags with aging
various thermal devices only focus on the outer layer and even if they can
contract and tighten the skin they cannot do that for the muscle and soft
tissue in a way that is done in surgery so visible sagging will persist even
minimally invasive procedure such as thread lifts can only lift the skin and
not the underlying muscle or soft tissue layers surgical lifting can tighten and
lift the muscle and soft tissue layers which leads to obviously visible and
superior results in appearing more youthful and ensures a longer-lasting
effect than just treating this top skin layer facelifts don’t address every
aging issue and additional treatments can be needed from volume augmentation
and maintaining skin quality while surgical face lifting and laser
treatment alternatives are often considered as the first treatment for
facial aging a significant aspect of facial aging is often not factored in
the facial foundation is bone bone loss has the most significant effect on
facial appearance this volumetric loss throughout the face notably in the
cheeks causes the facial structure to shrink and the face to look deflated
with less facial volume to support the skin the skin appears like it’s sagging
facial volume loss can be treated without surgery using a technique
called Structural Volumizing by placing thicker longer-lasting fillers deeper
than traditional filler placement at the foundational bone level we can restore
volume and give the face more definition since volume is placed at the bone level
and held in place by the muscle layer the filler doesn’t migrate like it tends
to do when placed just below the skin which is typical I would say that for
the majority of people who are trying to tighten and lift their skin without
surgery that structural volumizing will have a much more substantial benefit to
their appearance than heating the skin to try to shrink wrap their way to a
more attractive appearance a youthful face has volume and definition with a
soft and radiant glow to the skin by defining the problem you define the
solution lasers and other thermal treatments are perfectly suited for skin
resurfacing tightening collagen stimulation however if you’re looking to
lift what appears to be sagging skin a proper evaluation to determine the
degree of volume loss relative to the degree of skin and underlying tissue
sagging provides the key information needed for you to make an informed
decision when facial aging is approached from the inside outward volume provides
structure and the skin can be treated with lower energy non ablative lasers
PRP and gentle treatments to the epidermis patients come in asking for
the latest over hybrid heating device after educating them about bone loss I
provide more impressive results in 15 minutes with structural volumizing using
long lasting hyaluronic acid fillers then any shrink-wrapping heat technology
could ever produce I hope you found this information helpful thank you for your

What is the cost of ptosis surgery?

What is the cost of ptosis surgery?
Cost of any surgery is based on factors such as: surgeon’s fee, anesthesia, facility
cost and aftercare.
Surgical procedures are not commodities like electronic goods.
The results of your procedures are something you will live with for a long time.
Understanding the cost of delivering high level of care usually give my patients an
understanding of how we arrive at our fees.

After the operation, will my eyelid look the same as before?

After the operation, will my eyelid look the same as it did before?
The answer to this question is based on the objective of the eyelid surgery.
If you are having ptosis surgery, then elevating the height of the eyelid should improve the
appearance of your eyes.
If you have unilateral ptosis or ptosis affecting only one eye, I aim to maximize the symmetry
and shape with the other eye so your eyes look the same before you did before you developed

Once I had ptosis surgery, will I need any other treatment?

Once I’ve had ptosis surgery, will I need another treatment?
There are several factors that can impact if and when you need another surgery.
These factors include: the type of ptosis you have, the age when you had the procedure,
changes related to aging and your own tissue’s elasticity.
For example for someone who has congenital ptosis or ptosis you are born with has surgery
before the age of 6 and as they get old may need to get another surgery in their teen
years or young adulthood.
The more common type of ptosis called acquired ptosis occurs in later life and is caused
by the thinning or detachment of the tendon of the levator muscle which is the muscle
responsible for lifting the eyelid.
A common term for this type of ptosis is referred to as aponeurotic ptosis or levator muscle
The procedure to approach this type of ptosis in my experience can last for years without
needing any additional surgery.
Ptosis surgery may require enhancement during the first several months or years if there
is any issue related to the height, symmetry or contour.