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YouAsked is your online video channel for questions about cosmetic procedures.

You-asked by Dr. Amiya Prasad

If you're considering a medical cosmetic or reconstructive procedure, making the right choice is harder than ever. In world of "breakthrough, revolutionary and proprietary.....noise", people just like you have come to us to ask for honest and unbiased professional opinions.


We feature dedicated pioneers in cosmetic procedure education including renowned Manhattan Oculofacial Plastic surgeon Dr. Amiya Prasad, and world renowned innovator in hair loss treatment Dr. Gary Hitzig.


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You-asked by Dr. Amiya Prasad

A gentleman had hair transplant surgery 5 months ago and wants to know if PRP is a beneficial complementary treatment.

Dr. Amiya Prasad is a board certified cosmetic surgeon practicing in Manhattan and Long Island for over 20 years. Hair transplants have been a very big part of his practice. Recently, platelet-rich plasma (PRP) has really been a tremendous area of benefit to his patients not only just for hair but also in other areas such as the skin, scars and wrinkles treatment.

Dr. Prasad developed a treatment called Hair Regeneration. This is a combination of platelet-rich plasma and Acellular matrix. This is a standalone treatment for hair thinning. In fact, he has reached a point where he has done so few transplants because of the success of this treatment. For people who come to him with thinning hair who want a transplant, he explains to them that they can get better results by doing Hair Regeneration. Unfortunately, if someone has completely bald areas of the scalp, then transplant is the only option.

This treatment has also been a tremendous interest for patients who had a transplant because not all the hair that gets transplanted survives. With FUEs, it’s not uncommon for 30% of the hairs to not make it because of transection or hair grafts being damaged at the root. In addition, the number of grafts that can potentially heal may be down to 50%. When a hair transplant is done when hair is thinning, there’s trauma to existing thinning hairs that causes collateral loss. Patients who get transplants don’t see a dramatic improvement because the hair gets traumatized by the incisions made to place the grafts. This is why Dr. Prasad doesn’t do transplants as a primary procedure but the injection.

For patients who had the transplants, Dr. Prasad explains that it’s better to come within a month to 3 months after their surgery. During this healing phase, there may be an opportunity to help the grafts, especially if they had FUEs. When FUE grafts are actually harvested, majority go beyond the true permanent donor zone. Hair transplant doctors know this, but they rationalize that they have to get the number of grafts they need. Dr. Prasad sees this as borrowing from the future because if they are going to take hairs that are at risk of thinning, then they may not have that hair in the future.

Hair Regeneration can help protect and thicken those hairs in a combined way. The Hair Regeneration treatment may also need to be repeated, but Dr. Prasad doesn’t know that yet because he has up to 5 years of data. The majority of people he has seen for the treatment have been in the past 3 years.

Dr. Prasad thinks that PRP on its own can certainly be helpful, but the Hair Regeneration method is actually considerably more effective. Patients have an opportunity to try to save the existing hair as well as maximize the survivability of the grafts. They must remember that there’s a critical period where the graft has to take, otherwise it’s not salvageable.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regenerati…

To know more about platelet-rich plasma:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

Why PRP after a Hair Transplant Has Limited Effect, but a PRP Combination Improves Results

A gentleman had hair transplant surgery 5 months ago and wants to know if PRP [...]

A gentleman says he has 3 vertex type baldness. He has been using Minoxidil but had no significant result. He wants to know if a transplant would be the only cure for him.

Dr. Amiya Prasad is a board-certified cosmetic surgeon who specializes in hair restoration surgery in practice in Manhattan and Long Island for over 20 years. In the past several years, he developed an alternative treatment called Hair Regeneration which has turned out to be quite an effective way to treat hair loss, particularly in people who still have existing hair.

If someone is bald and they want hair placed where they don’t have hair, hair transplant is still the only option. However, in people who have thinning hair, Hair Regeneration is an ideal treatment. This treatment combines a material called Acellular matrix which was originally designed for wound healing, with platelet-rich plasma (PRP). Dr. Prasad has treated hundreds of patients around the world over the last 5 years, and he has a certain protocol that has turned out to be close to a 100% effective for male pattern hair loss.

Hair Regeneration is actually an injection treatment that takes less than 2 hours to perform. Dr. Prasad follows his patients very closely every few months to track progress of the thickening hair, and tracks the data to support the efficacy of the treatment. The earlier it is used on somebody, the more hairs can be saved and the more volume can be achieved. Even people who are Norwood 3-4 have had a lot of regrowth, and he has been very impressed with the results.

Dr. Prasad has developed a company called Trichostem® Hair Regeneration where its mission is to bring this treatment closer to many people. He is honored and privileged to give patients who come to him from all over the world for this treatment, which he wants to make more accessible. With this technique and formulation, he wants to ensure a certain level of quality. In most cases, depending on the level of hair loss, it is demonstrated that the injection can exceed the results of two hair transplant surgeries. The treatment is a fraction of the cost and downtime of hair transplantation, and it avoids the downward spiral of patients who undergo a transplant where they run out of donor area and may not have enough coverage.

Dr. Prasad has 5 years of data which show longevity. Someone may need to do this injection every 3-5 years, but doing this to keep the hair nice and thick is much easier and more desirable than getting a transplant every few years until they run out of donor area. Hair Regeneration is something that this gentleman should certainly investigate. More than ever, Dr. Prasad is very enthusiastic about helping people with hair loss and it has made a big difference for patients who come to him.

For more information about hair loss, please visit our website: http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regenerati…

you-asked by Dr. Amiya Prasad

Hair Transplant is Not the Only Treatment for Male Pattern Baldness – Non-Surgical Treatment

A gentleman says he has 3 vertex type baldness. He has been using Minoxidil but [...]

A woman says she has horrible crêpiness and wrinkling under her eyes. She wants to know the best treatment aside from fractional CO2 laser, which she has already repeatedly tried.

Dr. Amiya Prasad is a board-certified cosmetic surgeon practicing in Manhattan and Long Island for over 20 years. He also had fellowship training in oculofacial plastic surgery. Eyelid surgery and eye rejuvenation is a focus of his practice.

The majority of treatments for the under eye area have to do with some type of thermal energy, but unfortunately, there is a limit to what thermal energy can accomplish. In the 90s, doctors were using the original, very aggressive CO2 laser and it created a lot of good, tight results, but it also created undesirable results when used excessively. The pendulum swung towards less aggressive lasers such as the erbium laser which Dr. Prasad has used for many years. He also observed that people who came for consultations also did chemical peels and/or another type of laser repeatedly which made eyelid skin even thinner.

During aging, the skin loses collagen, blood supply and it becomes irregular. For the past several years, Dr. Prasad’s practice has been in the forefront of certain regenerative medicine and technology where he helped people using platelet-rich plasma (PRP). This uses the body’s own healing factors which are injected under the skin. Generally, when someone has this much crêpiness like this woman, with strategic placement, it has been able to significantly improve skin quality without using lasers.

This is not a onetime treatment. In the modern world, people want quick or immediate results. However, in treating skin, it can’t be beautiful overnight. There are certain limitations especially when someone has reached a certain age, has a certain amount of sun exposure, and if they have been smoking. They have to eliminate a lot of those potential toxic reasons for the crepiness.

Dr. Prasad has also done PRP with Acellular matrix for hair loss. He doesn’t necessarily place in under the eyelid with the same concentrations. With PRP, he builds tissue rather than heating. Sometimes, if someone’s skin is a little bit thicker, he’ll combine the effect of PRP with laser at the same time.

Dr. Prasad suggests that patients learn more about this modality and see what they can do from a more holistic approach. Clearly there’s only so much one can do to build the collagen. He agrees with the person and would not recommend lasers because they will not get significant improvement with more laser treatment.

To learn more about Platelet-rich plasma, please visit:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

Improving Wrinkles and Skin Quality Under the Eyes with Platelet-Rich Plasma (PRP)

A woman says she has horrible crêpiness and wrinkling under her eyes. She wants to [...]

A 68-year-old woman had a facelift 10 years ago, but her face has drooped since then from normal facial aging. She would like to know what her options are for a second facelift.

Dr. Amiya Prasad, a cosmetic surgeon, explains that this woman is clearly experiencing facial aging which may not be addressed with the same procedure she had 10 years ago. The quick lift that she had is a short scar facelift. It has a limited opening and it takes advantage of certain physical aspects of the face and the soft tissues called the SMAS or superficial musculoaponeurotic system. As people get older, these tissues sag. In the neck area, the skin tends to hang more from normal facial aging, and is not normally addressed in short scar facelifts.

The procedure that Dr. Prasad recommends is some type of face and neck lift. This will elevate the face and the neck more than a limited short scar facelift can do. The incision involves going from the temple area and down to the opening of the ear, then behind the ear, and then back to the hairline. This will move the sagging skin and tissues upward, but she needs a physical examination first to determine the exact procedure right for her. Whether it’s a deep plane facelift, a SMAS flap, a high SMAS or any other variation, experienced cosmetic surgeons know that they have to customize the procedure to the patient. The older one gets, the more skin there is, so doctors have to tailor procedures according to the patient’s problem.

In Dr. Prasad’s practice, he does all these procedures under local anesthesia with LITE™ sedation. One of its big advantages, like the original appeal of the short scar facelifts, was that there was no general anesthesia. He has been doing full regular facelifts without general anesthesia for close to 20 years. This would entail a longer operation. A quick lift type of procedure or anything in the same class is usually a 1-1.5 hour procedure, while a full face and neck lift is 2.5-3 hour range. Like any good facelift, it can last up to 5 to 10 years, which is dependent on the individual’s unique skin texture and quality as well as tissue quality. Everyone who gets lifted can look toned and natural, but unfortunately there is also a certain amount of elasticity and regression. It is important to define the things that matter most to the patient when they communicate to the doctor.

Dr. Prasad suggests that she meet with several doctors who perform more extensive lifts and not people who are limited to short scar lifts. A surgeon who can do a more extensive procedure may decide to do a quick lift because it’s the right choice for that patient. However, if someone doesn’t have that range, then they’ll try to do the same procedure on everybody. This is one of the problems a very well-known chain encountered when they tried to do seven of these surgeries a day which was absolutely overwhelming for any doctor to try to accomplish. This company had to go under and deal with several allegations.

Dr. Prasad recommends that she find a doctor she can trust, who is committed to quality and who would be there for her beyond the procedure. His personal bias is he prefers local anesthesia with LITE™ sedation as it is so much safer and it allows for a quicker recovery, and also allows for a more extensive procedure which is less prone to complications.

For more information about Face lifting surgery, please visit our website:

http://prasadcosmeticsurgery.com/pras…

you-asked by Dr. Amiya Prasad

Following up a Decade Old Facelift with a More Comprehensive Procedure that Includes a Neck Lift

A 68-year-old woman had a facelift 10 years ago, but her face has drooped since [...]

A woman has swollen dark under eye hollows. She wants to know the best treatment to address her under eye area.

Dr. Amiya Prasad is a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery. He is a specialist trained in oculofacial plastic surgery by The American Society of Ophthalmic Reconstructive Surgery. That means that his background training was first in eye surgery before he specialized in surgery of the eyelids and the areas around the eyes and face. He has been in practice for over 20 years in Manhattan and Long Island.

The puffiness or under eye bags represents lower eyelid fat prolapse. This means that the fat that is normally around the eyes pushes forward and creates a bulge that makes the eyes look puffy or swollen. The first line of treatment for a lot of people is they go to the store and buy various kinds of creams which claim to be able to solve these under eye puffy areas. Unfortunately they don’t work because the fat that is normally around the eyes is a volume and pushes forward like a hernia, so it also called herniated fat.

Below the area of the herniated fat, the eyelid-to-cheek area and the cheek area have volume loss, which is consistent with normal facial aging. Dr. Prasad wrote about this in a book a few years ago. The concept of facial aging has two elements: volume loss, and descent or sagging. People lose bone, muscle and fat as they get older. In addition, there is descent or sagging especially when they get to their 50s or as early as the mid-40s. Depending on family history, they can start manifesting both.

In Dr. Prasad’s practice, he first works on dealing with the dominant feature which is the puffiness under the eyes. The essential issue is to surgically correct that puffiness. When someone does research, they’ll learn about non-surgical options whether they’re thermal devices or injectables. However, judging by the amount of volume this woman has, Dr. Prasad doesn’t think that non-surgical modalities will be of value to her.

Dr. Prasad would probably do a transconjunctival blepharoplasty. This is a procedure where he treats the fat pockets from behind the eyelid so no incision is made on the outside. He’ll also treat the skin quality and skin overall appearance with platelet-rich plasma (PRP). This is derived from the patient’s own blood and uses their own body’s growth factors and healing properties to stimulate and improve skin quality. In certain patients, Dr. Prasad uses radiofrequency or fractional CO2 laser to improve skin texture or resurface the top layer skin. This combined approach gets the maximal aesthetics. He also discusses a strategy on how to address the adjacent areas that are not as important for her right now, but may become important after the big dominant factor is reduced. That area is the eyelid-to-cheek junction and the cheek area. Depending on what’s the desired outcome, there are solutions that include improvement of volume and surgical elevation depending on how extensively they want to rejuvenate their face.

Dr. Prasad does all these procedures under local anesthesia with LITE™ sedation. He has been doing this for many years and he has developed a very nice protocol so that his patients are able to recover faster and reduce the risks of having procedure compared to general anesthesia. He does the procedure in his own facility within both of his offices which are certified by the Joint Commission. This is the governing body that oversees hospitals and surgery centers for implementation of certain safety and protocols. There’s no difference between the quality of care regardless of the location as long as the safety focus standards are met and that’s of course of highest value.

Dr. Prasad suggests that she meet with experienced, qualified cosmetic surgeons. These are people who specialize in eyelids, particularly cosmetic eyelid surgery, not just reconstructive but also a lot of cosmetic patients. Cosmetic surgery is its own specialty separate from other areas. It’s a matter of not just the name, but what kind of practice the doctor has. She should meet with a doctor, get comfortable, look at their before and after pictures, and understand what she could expect after the procedure. One of the most satisfying procedures surgeons do is to help people with under eye bags because people feel that they look tired. Once it’s done, it really has a transformative effect on the facial appearance. It’s almost like doing a facelift in the right candidate.

For more information about eye bag surgery, please visit:

http://prasadcosmeticsurgery.com/pras…

To know more about platelet-rich plasma:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

How Excess Fat Under the Eyes Causes Eye Bags, but Losing Fat in Adjacent Areas Causes Hollowness

A woman has swollen dark under eye hollows. She wants to know the best treatment [...]

A gentleman had otoplasty (cosmetic surgery for the ears) before. However, his ears are still prominent and wants to know the best procedure to address his ear problem.

Dr. Amiya Prasad is a board certified cosmetic surgeon. Otoplasty is a procedure he performs in his practice and he can certainly give his perspective based on some anatomic principles. This can help patients understand how to choose procedures.

The area where there is an excess tissue is in the central part of the ear and this is called the conchal bowl. Prominent ears are related to increased protuberance of the conchal bowl and are called conchal bowl hypertrophy. To correct this, Dr. Prasad resects or reduces the cartilage and reattaches it to the side of the scalp in the area called the mastoid fascia. That procedure is more anatomic in comparison to other procedures that are sometimes offered like the setback procedure which is done particularly for patients whose cartilage is soft. Dr. Prasad has a suspicion that this is the procedure that this gentleman had done where sutures were used to pull the ear back into position. However, because the cartilage is a little brittle, it can break and create this potential irregularity.

Unfortunately, Dr. Prasad wasn’t there for the original surgery so he can’t say exactly what happened. A physical exam is helpful to determine his problem. If he is bothered with his ears then that can be addressed.

There is also an upper part of the ear which is referred to as the antihelical fold. The common issue for people who have prominent ears is the absence or lack of development of the antihelical fold. There are procedures, particularly one called the Mustard procedure where the sutures are placed in a certain way after the cartilage is weakened to try to recreate an anatomic fold.

Dr. Prasad suggests that this gentleman meet with doctors who perform otoplasty. It is a very interesting procedure that can have a dramatic improvement. If he wants to do both ears while one ear is the one that bothers him, he has to measure and compare it to the other ear and how it is projected away from the skin. There are a lot of nuances that can’t all be addressed with just a single photo with one angle. Based on the photo he submitted, some type of revision surgery is possible.

For more information about ear surgery, please visit our site:

http://prasadcosmeticsurgery.com/pras…

you-asked by Dr. Amiya Prasad

How Brittle Ear Cartilage Can Change Shape after Previous Surgery, and How it is Revised

A gentleman had otoplasty (cosmetic surgery for the ears) before. However, his ears are still [...]

A 21-year-old gentleman has hair loss. He wants to know if hair transplant is a good procedure for him at his age.

For many years, the standard therapy in the hair loss industry has been hair transplant. Unfortunately, it is never advisable for someone in their early 20s to get a hair transplant. The simple reason is when someone is losing hair quickly, there aren’t enough hairs to cover the area of hair loss.

Dr. Amiya Prasad is a board certified cosmetic surgeon. He trained in the time when hair transplants were done with big, round plugs that were taken out and placed in the scalp. He has lived through the different evolutions including micrografts, minigrafts and now follicular unit extraction (FUE). These are all great advancements and certainly the procedure has improved in some ways. However, regardless of the technology and the names, there’s only one simple physiologic reality – the donor area or the area at the back of the scalp has limited number of hairs.

In Dr. Prasad’s practice, he developed a treatment called Hair Regeneration. In fact, he developed a company at this point called Trichostem® Hair Regeneration because of its success. Essentially, this technology and method is to treat hair thinning by not doing hair transplant but using an injection treatment. This treatment has a combination of platelet-rich plasma (PRP) derived from the patient’s own blood combined with Acellular matrix which is a wound-healing agent. Close to a 100% of Dr. Prasad’s male patients see improvement.

Dr. Prasad is always anxious to help people understand that the earlier he catches someone, the better the results. If he can catch somebody as young as 18, he treats them. He hasn’t treated anyone under 18 for pattern hair loss but he does treatment in this age especially when there’s clearly a family history which he can confirm either from microscopic or biopsy.

Dr. Prasad explains that this gentleman is a better candidate for treatment like Hair Regeneration although he can never guarantee success. Sometimes, people are losing hair very aggressively and he may not catch them soon enough to get back as much hair as they would like. This is certainly a better option to consider than a surgical hair transplant.

At this point, Dr. Prasad suggests that he learn more about these options. He should also think about finasteride. However, patients who come to Dr. Prasad from all over the world are very much against the use of finasteride because of fear of long-term sexual side-effects. Clearly, he has been able to improve that his treatment works independent of pharmacologic assistance.

For more information about hair loss, please visit our website:

http://nyhairloss.com/

To learn more about Hair Regeneration, please visit:

http://nyhairloss.com/hair-regenerati…

you-asked by Dr. Amiya Prasad

How to Treat Rapid Hair Loss in the Early 20s When Hair Transplants Aren’t Adivised

A 21-year-old gentleman has hair loss. He wants to know if hair transplant is a [...]

A 29-year-old male has noticed discoloration, tear trough deformity and bagginess developing under his eyes. He wants to know the procedures that address all those issues.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon and a board certified cosmetic surgeon practicing in Manhattan and Long Island for over 20 years. Addressing under eye aesthetics is a very significant part of his practice. He also figures out the right combination of solutions every day.

Puffiness under the eyes is caused by lower eyelid fat prolapse. This means that the fat around the eyes has pushed forward and created the bulge. Dr. Prasad often refers to it as herniated fat. This bulge is not because of being overweight but is typically a genetic issue. In other words, it tends to run in families. In his practice, he has helped people in 3 generations with exactly the same issues, and with the same onset occurring around the same age range.

Dr. Prasad explains that the eyelid skin is half a millimeter in thickness. With the absence of allergies or sinus issues, the bluish discoloration is because of the transparency of the skin. In lighter skin people, the color of the muscle and blood vessels can be visible underneath the skin.

Interestingly, this gentleman asked about tear trough deformity. The paradox here is he has too much bulge in one area, and yet it looks hollow in another area – this is the relative contrast of an elevation next to a depression. In the modern world, there are more than a few options to address this issue. Dr. Prasad’s decision depends on the degree of fat prolapse, and whether or not to fill the tear trough or reduce the bags. However, in this gentleman’s situation, he would be a candidate for lower eyelid transconjunctival blepharoplasty. This surgical procedure addresses the fat pockets from the inside of the eyelid, and sculpts and reduces the fat so that he looks like as if he never had the bags under the eyes.

To help with skin quality and texture, Dr. Prasad routinely uses platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood that has wound-healing elements. By improving skin quality, there can be benefit to the discoloration. He explains that he can’t necessarily eliminate it because the skin is so thin, but he can try to build up the skin quality which is within its capacity to improve. Sometimes, people’s skin quality diminishes from environmental factors such as sun exposure and smoking, so if those are factors are contributing to his situation, he needs to address that.

In Dr. Prasad’s practice, he does transconjunctival lower eyelid blepharoplasty under local anesthesia with LITE™ sedation. In his experience, it is better compared to general anesthesia because patients recover a lot faster, and there’s no paralysis or tube in the throat that is typical of a general anesthetic procedure. He combines this with platelet-rich plasma depending on skin texture. He often also uses fractional CO2 laser, but that requires more of an up close physical examination so that he can look at the skin texture and quality.

Fillers used in the under eye or tear trough area are feasible up to a point. In Dr. Prasad’s practice, he sees more patients who have fillers in the hyaluronic acid family such as Restylane and Juvederm placed in the tear trough area. These are great treatments, but in the patients who had too much puffiness, they tend to not work so well because the amount of filler needed creates even more swelling and puffiness under the eyes. In such cases of filler overuse, Dr. Prasad uses an enzyme called hyaluronidase to dissolve that filler. There is also an art to filler application.

Dr. Prasad recommends that he should meet with qualified, experienced cosmetic surgeons. His bias is always towards specialists or people who have extensive experience and focus in eyelid surgery. He must also take a look at before and after pictures and get a sense of the type of anesthesia they use. Most importantly, he must be comfortable with the doctor. In cosmetic procedures where your personal appearance is at stake, one should not shop on price, but shop on quality and comfort.

For more information about eye bag surgery, please visit:

http://prasadcosmeticsurgery.com/pras…
To know more about platelet-rich plasma:

http://prasadcosmeticsurgery.com/dr-a…

To know more about LITE™ anesthesia, please visit:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

Eye Bag Removal is a Surgical Solution, but Adjacent Discoloration is Treated Non-Surgically

A 29-year-old male has noticed discoloration, tear trough deformity and bagginess developing under his eyes. [...]

A gentleman has acne scars in his cheek area. He is confused with what option to use to make those scars go away.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that one key characteristic of many people with acne scarring is that they frequently bounce from one doctor to another looking for the next best thing. At some time, they’ll learn about one laser and then they’ll go to another place because they heard of another laser. The reality is that one modality or one combination doesn’t work the same way for two people.

Acne scarring has a lot of variables and complexities that have to be addressed. There are modalities that help it such as subcision, platelet-rich plasma (PRP) and the use of fillers. When Dr. Prasad meets with a patient, he tells them that if they’re going to work with him, they have to be committed to doing the treatment, see how they respond to it and then doing another treatment that is based on that response. When patients shop technologies and prices, they’re going to have a lot of disjointed and disconnected treatments and they’re going to have a lot of doctors who are going to sell that procedure. However, Dr. Prasad’s philosophy is that he wants his patients to feel that he is committed to taking care of them and helping them understand what they need. He also figures out what the right budget is.

Dr. Prasad says that PRP is a great solution or technology to help people with acne scars. He has used it very successfully in scarring such as acne scars. He combines PRP sometimes with Acellular matrix, subcision, or with hyaluronic acid fillers.

Dr. Prasad suggests that this gentleman must meet with a doctor and really get a deep conversation as to what their vision is based on what they would recommend and what the choices are based on the results. If the results go with the way they want, or if the results don’t go the way they want, he must stick with the doctor because they have a lot of tools or options to use. These tools that are used by the hands of a doctor, especially with experience, can be used effectively. The patient also has to be committed to a long view because there’s no onetime treatment that’s guaranteed to make all the acne scars look good.

To know more about platelet-rich plasma, please visit:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

Why No Single Acne Scar Treatment that Works on Everyone – Options to Consider with Your Doctor

A gentleman has acne scars in his cheek area. He is confused with what option [...]

A 28-year-old woman has hated her hereditary under eye bags all her life. She wants to know if transposition of fat is a good procedure for her and if it would give her a hollow appearance.

Dr. Amiya Prasad is a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery. His background is also in eye surgery and oculofacial plastic surgery with fellowship training in the American Society of Ophthalmic Plastic and Reconstructive Surgery. He is also a specialist in cosmetic reconstructive surgery of the eyes. He has been in practice in Manhattan and Long Island for over 20 years.

Dr. Prasad explains that under eye bags are caused by fat prolapse, with many options to address it. However, many patients are afraid that they might look hollow after eyelid surgery. Most of the time it isn’t an absence of fat that causes the hollow look, but lower eyelid retraction where the lower eyelid being pulled downward from skin removal during lower eyelid surgery. There is a relationship between the eyelid area, the orbit or the space around the eyes, and the cheek area. If someone has a very flat appearance, sometimes they may interpret that once the bags are gone, they look hollow. When he assesses a patient, he always looks at these relationships and discusses with them what they can expect after surgery. Sometimes, the tear trough area, the eyelid cheek junction, and the submalar area can be relatively hollow. All of these go under the umbrella of hollowness.

Unfortunately, this woman feels that she can’t trust the doctor which is not a good thing. One should feel comfortable with their doctor. Anyone who has trained in a surgery specialty, who performs cosmetic surgery and has a lot of experience with eyes, certainly draws from their experience to give an opinion. When the doctor says that the transposition may not stay where you want it to, certainly Dr. Prasad would say that this doctor is correct. For several years, the idea of moving fat from the orbit into a space below the orbit has come and gone in different ways. There will always be doctors who would disagree in what they do, but there is also a lot of difference in how they do their procedures.

From Dr. Prasad’s own experience with fat transposition, it does have a place but it does have a limited indication. As a specialist, he has seen a lot of patients who had procedures like this who come in 2 years later and still look puffy. It’s because the transposed fat didn’t stay where it was intended. Part of it may have disappeared and the rest of it ended up back to the eye socket.

In Dr. Prasad’s consultations, he tells his patients that the puffiness under the eyes is caused by fat that has moved forward and created that herniated look. One should imagine how the eyes would look like if the fat wasn’t there anymore. That means the eyelid would follow the natural shape of the eye and will follow the shape of the rim. If there is volume loss along the rim or below the rim, then that can be addressed in a variety of ways.

Dr. Prasad suggests that she should meet with other doctors to get more confident about which doctor she feels comfortable with. In her situation, Dr. Prasad would perform a transconjunctival blepharoplasty which means a procedure done from the inside of the eyelid. He often combines this treatment with platelet-rich plasma (PRP). It helps with skin quality and volume of improvement in the eyelid to cheek junction. This combination has been very successful for him for the past 20 years of practice doing this type of approach whether it’s resection, transposition or any other variations. There is an art to doing this so an artistic eye, and a sense of proportion of how much to take and to leave behind are also important factors. The success of the procedure also depends on the individual patient and other factors such as skin thickness, skin quality, the risks and benefits. She has to think of all these things and have these factors articulated clearly so she can make an informed decision.

For more information about eye bag surgery, please visit:

http://prasadcosmeticsurgery.com/pras…

To know more about platelet-rich plasma:

http://prasadcosmeticsurgery.com/dr-a…

you-asked by Dr. Amiya Prasad

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A 45-year-old woman has deep hollow eyes that have wrinkles when she smiles. She is confused on what treatment to choose and if she should see an oculoplastic surgeon for her case.

Dr. Amiya Prasad explains that there are many ways to enhance the appearance of the under eye area which relates to the vision the doctor and patient share. Certainly, there is no refuting that oculoplastic surgeons are more experienced with eyes because that is the focus of oculoplastic surgery. However, even among oculoplastic surgeons, there’s going to be some variability. As an oculoplastic surgeon, Dr. Prasad’s practice is focused more on cosmetic procedures which give him a different perspective in terms of aesthetics and style in doing surgery. In addition, he also performs facial and body procedures like breast, body and extremity surgery.

Dr. Prasad wrote a book called “The Fine Art of Looking Younger” where he explained that facial aging is a combination of volume loss and descent. For some people, the solution for facial volume loss and hollowing is cheek enhancement whether it is the use of fillers such as Radiesse or Sculptra as well as the use of facial implants such as sub-malar or combined implants.

In Dr. Prasad’s practice, he approaches the facial area in a different way. He evaluates the face and assesses the wrinkles in the relaxed state known as static wrinkles and the expressive state known as dynamic wrinkles. He often recommends a combination procedure to improve the appearance of wrinkles. For dynamic wrinkles he uses Botox or Dysport to lessen muscle activity and reduce wrinkles. For static wrinkles, he uses a material called platelet-rich plasma which is drawn from the patient’s own blood to improve the skin quality. He would also use fractional CO2 laser or the use of medical micro needling for people who have pigmentation because a thermal device may not be ideal for them. And lastly, to address hollowing in the under eye, he would typically use a filler such as Restylane.

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