How to Speed Up Facelift Recovery

Dr. Amiya Prasad uses local anesthesia with LITE™ IV sedation

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When you think about cosmetic surgery, what often comes to mind is the facelift. For years, facelifts have been the gold standard in facial rejuvenation surgery to address sagging skin in the cheek, neck, and jawline areas. It’s generally assumed that facelifts require a long recovery process. In the past, this prolonged recovery time was afforded by predominantly wealthier people.

facelift recovery facility

Facelift was considered a surgical procedure for wealthy people due to the cost and long recovery process


When I was training in facial cosmetic surgery, facelifts involved general anesthesia and an overnight hospital stay. It also meant weeks of uncomfortable swelling that required large dressings and drains. While observing this process, I began thinking of ways to make facelift surgery less difficult and stressful for patients. I wanted my patients to get the most out of having a facelift procedures without compromising on quality and longevity of results. In the course of my practice, I’ve developed methods and systems, which allow my patients to enjoy an improved appearance with minimal risk and minimal downtime.

General Anesthesia vs. Local Anesthesia

One significant cause of longer facelift recovery is having general anesthesia. Under general anesthesia, a patient is completely unconscious and paralyzed which requires a breathing tube in the throat and a mechanical respirator to keep you alive. General anesthesia carries risks and complications which are specific to this type of anesthesia. Recovering from general anesthesia can be uncomfortable and prolong the recovery time

Patient on respirator during surgery

Patient under general anesthesia needs a respirator for breathing during surgery


In many cases, recovering from the effects of general anesthesia is more difficult than recovering from the actual surgery. After surgery, facelift patients can still suffer from the effects of general anesthesia such as nausea, vomiting, and memory loss. Oftentimes, patients are required to stay overnight at a recovery facility for monitoring and postoperative nursing care.

facial patients require extensive facial and neck bandages

Facelift patients under general anesthesia take longer recovery time and require extensive facial and neck bandages (this is not an actual patient)


Facelift patients often also require extensive facial and neck bandages, as well as drains that require regular dressing changes.

In my practice, I use local anesthesia with LITE™ IV sedation when performing facelift surgery. LITE™ IV sedation allows my patients to be in a relaxed state throughout the procedure. They are generally more comfortable and feel good after surgery. We perform surgery at our own operating facilities within our own office. Our facilities are managed like hospital facilities which reflects our commitment to safety, sterility and maintaining appropriate emergency equipment should the need arise.

Dr. Amiya Prasad uses local anesthesia with LITE™ IV sedation

Dr. Amiya Prasad uses local anesthesia with LITE™ IV sedation when performing facelift surgery. A light facial dressing is used and you can return home shortly after surgery


After surgery is completed, a light bandage is placed without the need for any drains. We typically monitor our patients for 1-2 hours before they go home. A responsible adult is necessary to accompany you going home.

What To Do After A Facelift?

Post-op care instructions involve putting antibiotic ointment where sutures are placed.

Staff attending to patient after operation

Antibiotic ointment is placed on the sutures after surgery


Antibiotic ointment is used for about 3 days to minimize the risk of allergic reaction to the antibiotic. A petrolatum-based ointment is used after 3 days to maintain a moist environment for optimal wound healing. Pain medication are typically not necessary. Sutures are removed after one week and patients can return to work in about a week to 2 weeks after surgery.

Antibiotic ointment

Over the counter petrolatum based ointment helps incision healing


Whether it’s a limited mini lift to an extended face and neck lift surgery, there is no compromise in the quality of the surgery to insure the best results. The deeper tissue often referred to as the superficial musculoaponeurotic system, is addressed the same way as any facelift procedure typically performed under general anesthesia. I perform the full range of facelifts with this approach, from short scar mini lifts with SMAS plication, SMAS flaps or imbrication as well as deep plane facelifts.

Deep plane facelift and neck lift before and after

Dr. Amiya Prasad performs different types of facelifts  such as short scar mini lifts, SMAS and deep plane facelifts

Quick Recovery Facelift

An important aspect of healing after facelift surgery is related to the length of the incision. Traditional facelifts often have longer incisions that go behind the ear and into the hair. In a procedure with a shorter scar such as a MACS facelift, the incisions can extend to the outer corner of the eyelid and be conspicuous.

Before and 1 week after short scar quick recovery facelift

Length of incision is a contributing factor to facelift surgery recovery. Quick Recovery Facelift has shorter incisions that can look good after about a week


Incisions for the Quick Recovery facelift are typically barely noticeable. I design the placement with you so you understand the reasons for the design and know where the incisions will be before you have your procedure.

Short Scar and Deep Plane Facelifts

The short scar facelift I perform is not a short-cut procedures. I typically choose this type of facelift for people who have minimal neck skin excess as well a people who’ve had previous facelift surgery.

Some patients are candidates for deep plane facelift surgery. The term “deep plane’ refers to a level of tissue and is a technical term. It does not mean that it’s a better procedure as is often claimed by surgeons trying to market themselves. I discuss with you the option of having a deep plane facelift and the potential benefits of this approach.

Deep plane face and neck lift before and after

Deep plane face and neck lift is a procedure more suited for patients who have significant skin laxity in the neck and under the chin


The type of incision is based on the specific objectives of the surgery. Generally, if there is a significant amount of excess neck skin, a face and necklift surgery is appropriate.

Face and necklift incisions are customized to the needs of the individual patient


Some doctors may claim to only perform deep plane facelifts exclusively, implying that they know techniques that other surgeons don’t. Surgeons who are trained formally such as through The American Board of Cosmetic Surgery are trained in the full spectrum of facelift surgery including deep plane facelift.

I  routinely use regenerative technology such as PRP or platelet rich plasma. I routinely apply a regenerative wound healing material called extracellular matrix or Acellular matrix.  This technology enhances healing so that I often see in about a month the incisions are usually virtually imperceptible.

1 month after using Acellular matrix

Regenerative medicine technology with acellular matrix enhances healing so that 1 month after the incisions can be practically unnoticeable

A Natural Aesthetic Style

A quick recovery time is important as is the aesthetic outcome. Whether it’s eyelid surgery or facelift surgery, I believe in a natural aesthetic. I strive to maintain the character of the face so my patients look like themselves after any procedure. My facelift and eyelid surgery patients often tell me how much they like looking like younger versions of themselves.

Full recovery after facelift surgery

Dr. Prasad philosophy is that facelift patients should look like younger versions of themselves

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    The Best Treatments for Lines around the Mouth

    types of lines around the mouth

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    Lines around the mouth, or perioral area, is a common concern I frequently hear about. These lines can remain visible even without movement, or become more pronounced with muscle activity. I’ll discuss some cosmetic treatments that can address these particular concerns.

    The most common types of lines that occur around the mouth area are vertical lip lines, nasolabial folds, and mesolabial folds. These folds occur due to a decrease in facial volume from loss of fat and soft tissue. A general reduction in skin quality as we age can also contribute to this.

    3 types of lines around the mouth

    There are 3 common types of lines around the mouth: vertical lip lines, nasolabial folds, and mesolabial folds.

    Vertical Lip Lines

    Vertical lip lines are pronounced creases that occur above the upper lip when the lips are pursed. This is caused by the activity of the orbicularis oris muscle. To resolve this, a neurotoxin like Botox is used to reduce muscle activity. This then reduces the depth of the creases, making them less visible.

    Botox typically takes about 3 days to take effect, with the full effects manifesting in about 2 weeks. At the 2-week mark, I evaluate the results and see if any enhancement is needed. The effects of Botox usually subsides over several months, so maintenance treatments are advised every 4 months.

    Vertical lip lines before and after Botox

    Botox can help vertical lip lines, which can fully take effect after 2 weeks, and subsides over several months.


    Volume loss in the fat and soft tissue layers beneath the skin are also responsible for vertical lip lines. Volume loss reduces projection above the lip, resulting in lines becoming more prominent. These lines can be filled and smoothened out with the help of a filler like Restylane or Juvederm. Filler treatment can be performed in a few minutes and can last anywhere between 6-12 months.

    Vertical lip lines before and after fillers.

    Hyaluronic acid fillers can improve vertical lip lines. Treatment can be performed in a few minutes and can last anywhere between 6-12 months.


    Diminishing skin quality is another known cause for vertical lip lines. As we age, our skin naturally loses collagen and elasticity. To combat this, treatments like laser resurfacing or radiofrequency heating can be employed. These treatments induce a controlled injury response that stimulates collagen production and tightens skin.

    vertical lip lines before and after laser

    Laser treatment can be used to resurface the skin above the upper lip, tighten the skin, and stimulate collagen to improve the depth of vertical lines.

    Nasolabial Folds

    Nasolabial folds, or parentheses lines, bracket both sides of the nose and mouth areas. Nasolabial folds become more pronounced as age-related volume loss progresses. To address this, I perform a procedure called Structural Volumizing. With this method, thicker hyaluronic acid fillers are strategically placed in the cheek and mid-face areas at the bone level.

    Before and after of Structural Volumizing performed by Dr. Prasad

    Dr. Amiya Prasad treats nasolabial folds with Structural Volumizing, also called Y Lift, where thicker fillers are placed at the bone level, and underneath the muscle layer.


    As a surgeon with extensive experience with facial implants and facial fracture repair, the Structural Volumizing technique came naturally to me. Instead of placing implants on top of the bone, I worked on the technique of placing thick, long-lasting fillers instead.

    Conventional filler placement puts the filler just below the skin layer. Placing the filler deeper restores volume where it is most needed. This method also prevents the filler from shifting around under the skin. Deeper placement also avoids the typical “doughy” appearance that is commonly seen. This particular method produced results that can last for 1-2 years.

    Structural Volumizing before and after

    Deeper placement of filler for nasolabial folds can last for 1-2 years.

    Mesolabial Folds

    Lines that begin at the corner of the mouth and go downwards are called mesolabial folds, or marionette lines. Similar to nasolabial folds, these lines are also caused by volume loss and are often treated together using the same methodology. Aside from hyaluronic acid fillers, Radiesse is often used in this area, but it’s not made of hyaluronic acid, but of calcium hydroxyapatite, which is similar to bone. The difference is that calcium hydroxyapatite cannot be dissolved or reversed like hyaluronic acid filler. The effects of Radiesse last about a year, while thicker hyaluronic acid fillers like Juvederm Voluma can last about 2 years.

    Marionette lines treatment before and after

    Fillers like Juvederm Ultra Plus and Juvederm Voluma are treatment options for marionette lines.


    Mesolabial folds are addressed by placing volume in the jawline area by means of Structural Volumizing. As we age, loss of definition in the jawline affects the appearance of the mouth. Adding volume to this area improves definition and makes the overall contour more continuous and angular.

    Generally, filler treatments take only minutes to perform. Minimal swelling can occur but usually resolves quickly. Patients can even undergo this treatment shortly before an important event like a wedding. My patient care policy post-treatment includes regular check-ups to monitor results and see if any additional enhancements are needed.

    In my opinion, filler placement should be treated as seriously as facial cosmetic surgery. I believe that once you’ve entered below the skin, the procedure is already considered invasive. As such, it should be handled with the same standards one uses for all invasive procedures.

    Nasolabial and mesolabial folds before and after filler treatment

    Filler treatments take only minutes to perform to improve fine lines around the mouth. Minimal swelling is expected but can resolves quickly.

    Filler Treatments are Not All the Same

    In many practices, filler treatment can be administered by non-physicians and doctors who don’t perform surgery. It’s important to understand that filler treatment is a procedure that requires skill and finesse. Knowledge of surgical techniques is important, especially when placing filler in deeper areas. I do advise patients to meet with doctors who can perform both surgery and filler treatment to get an unbiased recommendation of what will be best for a particular person.

    I personally feel that my experience as a cosmetic surgeon has been very useful in achieving outstanding results. My expertise in facial anatomy and a natural aesthetic style allow my patients to have consistently satisfying results with minimal swelling and rarely any bruising. Choosing fillers made of hyaluronic acid are ideal for longevity, safety, and reversibility.
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      How Long Do Cosmetic Fillers Last?

      cosmetic fillers injection

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      Cosmetic fillers are very effective non-surgical solutions for facial volume issues such as hollow under eyes, lip enhancement, cheek definition, the lack of chin projection, and other problems related to genetics or age-related volume loss. Cosmetic fillers can also treat other issues such as wrinkles, lines, and folds as well as acne scars, and even thinned earlobes. Although filler can be used for many situations, some people have reservations about filler treatment because of longevity, and concerns about putting something they think is not natural into their body. I’ll discuss how I counsel my patients who have the same questions and concerns about fillers.

      cosmetic fillers injection
      Cosmetic fillers are a popular non-surgical procedure to add youthful looking volume.

      People often want to improve their appearance caused by loss of volume. As we get older, our faces gradually lose bone, muscle, fat, and soft tissue. In some younger people, a genetic lack of volume in the face such as in the cheeks and eyes make them look older and more tired than they actually are. Facial volume loss can also be seen in people who are very athletic who have very low body fat, or if you ‘ve lost a lot of weight from diet or weight loss surgery.

      Patient look younger after cosmetic filler treatment
      Hollow faces from aging and/or weight loss can look younger with non-surgical filler application

      A lot of people who we see come in requesting fillers which are permanent so they can avoid having to come back regularly for filler placement. In my surgical practice, I’ve had patients come from around the world to have me remove permanent and semi permanent fillers such as silicone and polyacrylamide.

      semi-permanent filler removal after complications
      Permanent or semi-permanent fillers are prone to complications from infection, foreign body reactions, and difficulty in removal

      In addition, if an infection such as a biofilm were to occur, the filler would have to be removed surgically. The reality is that you can never completely remove all the filler, which means that recurrent infections would be likely. In my practice, for any procedure, my recommendations are based first on minimizing risk, and being able to address any issues that may arise quickly and safely. I don’t recommend the use of permanent or semi-permanent fillers. Further, as aging progresses, these fillers will not easily adapt to changing anatomic relationships. There are more than a few celebrities who have publicly expressed regret about having permanent fillers, particularly in their lips.

      semi-permanent filler removal surgery
      Permanent and semi-permanent fillers require surgical removal, and it’s likely that not all the filler material can be removed.

      In any discussion about a natural filler, the subject of fat grafting always comes up. In order to address facial volume loss at the bone level, fat grafting cannot be used. Fat grafting is placed under the skin, which makes it similarly susceptible to the same issues as superficial filler placement. Healing from fat grafting is unpredictable with frequent complaints about lumpiness and asymmetry. Fat grafting does not meet my criteria for predictability and benefit from placement at the bone level.

      fat transfer for volume loss
      Fat grafting can be done underneath thicker skin, but it is a surgical procedure, and some fat will be absorbed by the body, requiring a second procedure.

      My preferred injectable filler material is hyaluronic acid. Hyaluronic acid fillers meet my criteria for safety, predictability, versatility, and reversibility. Hyaluronic acid occurs naturally in the body, they don’t have the same risk of foreign body reaction like semi-permanent fillers.

      Hyaluronic acid fillers come in a range of thickness and longevity allowing me creative flexibility to help my patients look their best. Hyaluronic acid fillers are also reversible as they can be dissolved with the injectable enzyme hyaluronidase.

      before and after hyaluromic acid fillers on nasolabial and mesolabial folds
      Hyaluronic acid fillers can be applied in minutes, without surgery, with thicker fillers lasting 1-2 years.

      How long hyaluronic acid fillers last depend on the structure and composition of the filler, as well as an individual’s rate of metabolizing the material.
      Longevity of hyaluronic acid fillers

      I use softer hyaluronic acid fillers in the under eye area for hollow looking eyes, and to camouflage minimal eye bags, and for plumping the lips. These fillers include Restylane, Restylane Silk, and Juvederm Ultra. A filler like Juvederm Volbella can can be useful for vertical lip lines above the upper lip. These fillers last anywhere between 6-12 months before they are metabolized, and need to be reapplied.

      Lip augmentation with hyaluronic acid filler
      Lip enhancement is among the most popular cosmetic filler procedures for younger and older people

      I often combine fillers in the under eye area with platelet-rich plasma, or PRP, which is a concentration of wound healing and growth factors derived from your own blood. PRP helps improve the skin quality and skin thickness under the eyes, as well as discoloration and pigmentation which often accompany hollowness, often described as dark circles under the eyes. PRP often extends the effective life of filler under the eyes, and the two materials work well together.
      Fillers in medium thickness and viscosity are usually used for nasolabial folds, the folds around the upper mouth and lower nose, often called the parentheses lines; and the mesolabial folds, the folds around the lower mouth otherwise called the marionette lines.

      nasolabial folds and mesolabial folds treated with cosmetic filler
      Nasolabial and mesolabial folds, commonly called smile lines and marionette lines, can be treated with cosmetic filler

      These areas have thick skin, but still have a fair amount of movement when smiling and talking. Both these types of folds around the mouth are due to volume loss due to aging. These types of fillers include Restylane Refyne, Restylane Defyne, which last between 6-12 months, and Juvederm Vollure that can last up to 18 months.

      The thickest hyaluronic acid fillers can be used on bone structure and doesn’t really move with facial expression. Areas where I use these thicker fillers include the upper cheeks, jawline, and chin. These areas are prone to bone loss which naturally occurs with aging.

      Jowls and jawline improved with cosmetic fillers
      Jowls and jawline continuity can be improved with thicker filler added into the mandibular notch along the jawbone.

      The cheeks appear to deflate due to the diminishing cheekbone, as well loss of muscle and soft tissue. The jawline may appear to sag and lose continuity due to the hollowing of an area called the mandibular notch. The chin can lose projection as bone diminishes. I prefer to use Juvederm Ultra Plus, which can last about a year, and Juvederm Voluma which can last up two years. Restylane Lyft can also be applied in these areas, and can last up to 18 months. Successful placement of facial fillers for diminishing facial volume at the cheeks, chin, and jawline is highly dependent on technique.

      Deeper placement of hyaluronic acid fillers in the cheeks can avoid the pillowy look
      The Structural Volumizing technique can be applied to the cheeks, without looking soft and doughy like traditional filler placement

      Most doctors place these fillers more superficially at the dermal and fatty tissue layer. At this level the skin cannot support a significant volume can be weighed down. The filler can shift and make the face look doughy. I use my experience as a facial cosmetic surgeon with extensive experience with facial implants to place filler at the deeper layers, atop the bone structure and under the muscle layer for more natural looking results. This technique is called Structural Volumizing, and is practiced by very few doctors. It results in a more defined and balanced facial structure, and can even have a lifting effect.

      cosmetic filler at the dermal level can migrate and look heavy
      Most doctors place filler at the dermal level, where filler can migrate, and look heavy
      cosmetic filler placed at fat or soft tissue level
      Filler is often placed at the deeper fat or soft tissue level, but it still can’t hold much filler material, and can look soft or heavy

      By restoring volume at the bony structure level, the skin and soft tissue that may appear to have collapsed and descended due to volume loss become more defined and the overall effect can produce a vertical lift. Structural Volumizing requires more facial filler than traditional placement as it’s placed at the foundational level of bone e where most of the volume loss occurs therefore, more volume is needed. At this level, results can actually last longer than more commonly performed superficial filler placement.

      Y Lift place filler at the bone level
      Structural Volumizing/ the Y Lift can place filler between at the bone level, between the muscle layer, which is a much more solid foundation, and the muscle can hold it in place so it looks firm and contoured.

      This is an exciting time for people interested in improving their appearance with safety, predictability and convenience. In my practice, the use of hyaluronic acid fillers has been a great tool for me to help my patients. I would remind anyone considering having fillers to understand that fillers are just tools, or materials used in the hands of a sculptor. The doctor’s expertise, experience and artistry are critical to achieve the best results for you. Recognizing that filler placement needs to be done at regular intervals, its very important for you to find a doctor who you feel comfortable with. This means someone who shares your aesthetic vision, who communicates well and makes you feel at ease.

      Structural Volumizing by Dr. Amiya Prasad
      Structural Volumizing/ the Y Lift allows patients to have youthful volume that looks contoured and full, without looking soft and pillowy like traditional filler placement

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        The Do’s and Don’ts of Cosmetic Surgery

        Doctor shouldn't rushed consultations

        Do your research

        Information overload can make research overwhelming. Marketing and turf battles between doctors makes it difficult to distinguish professionally credible information from financially motivated scare tactics. There are still a good number of actual caring and ethical doctors. Advancement in medical procedures and technologies combined with higher standards for results is an opportunity for patients to find the right super specialist for them. For example, As a Cosmetic Eyelid Surgery specialist in practice for over 20 years, I can assure my patients about the optimal strategy for their eyelid issues in a way that would be different from a general plastic surgeon who mostly performs body procedures.

        Research into cosmetic procedures
        Research can help in finding specialized doctors who are experts in your specific cosmetic issue.

        Do expect your doctor to spend time with you

        It’s often perceived that a busy practice is a sign that the doctor is good. Although I’m busy, I never rush through a consultation. The consultation is a critically important time for you to learn and see if the doctor has a personality you feel you can trust with your health and appearance. A consultation is also a discussion. In my practice, the patient isn’t only selecting me but I’m selecting the patient. I avoid performing procedures on people who I’m not comfortable with. You should be comfortable with your doctor’s technical abilities and their personality.

        Doctor shouldn't rushed consultations
        Consultations shouldn’t be rushed, and the personalities and expectations of the patient and the doctor should be a good fit

        Do ask

        If you don’t ask, you may be left with questions. Ask to look at your surgeon’s before and after pictures. Ask for a step-by-step explanation of the procedure you’re looking into, including what type of anesthesia. Ask about your surgeon’s specialty area and how often they have worked on similar cases such as yours. I find that a patient who asks questions also learns about options they didn’t think about and have a better outcome.

        patient asking questions to Dr. Prasad
        Ask your doctor whatever you can to make sure you’re getting the treatment and results you want.

        Do tell your surgeon your full medical history

        An issue, which appears to be a cosmetic problem may also be associated with a medical condition. For example, a condition such as eyelid ptosis occurs when the eyelid level droops down. Oftentimes, there is also hooded skin. A plastic surgeon may remove the hooded skin without treating the eyelid ptosis. The plastic surgeon may not have been made aware that the patient sees an ophthalmologist who has been treating the patient with steroid eye drops, which could have contributed to the eyelid ptosis. The take home message is to disclose every detail about your medical history so your cosmetic procedure can be performed safely and successfully.

        Review your detailed medical history with your doctor
        Review your detailed medical history with your doctor prior to any procedure to avoid complications

        Do be open to a combination approach

        One procedure can be part of a solution for a more comprehensive treatment strategy. There may be a combination of 2 or 3 different treatments which can lead to a better outcome. For example, if a patient has concerns about under eye bags, they may not appreciate the bone structure which is lacking and contributes to the prominence of the eye bags. I find that with education and reviewing the patient’s photos from different angles that my patients appreciate the knowledge gained and the opportunity to have a procedure such as fillers to enhance the cheekbones at the same time as surgery for under eye bags. I often combine laser procedures and PRP (platelet rich plasma) treatment to help the skin look more even toned and vibrant at the same time I perform injectable treatment or surgery.

        PRP and Laser combined to treat dark under eye circles
        A combination of surgical and non-surgical procedures most often leads to the best possible results

        Don’t fall for shortcut miracle procedures.

        Shortcuts in medicine do not end well. A company claiming to perform a “revolutionary facelift” procedure with multiple offices and a pop singer from the 70s advertising for them could not hide the countless botched surgeries and fake online reviews which they forced employees to write. As a multispecialty trained Board-certified cosmetic surgeon, I have no limits on the level of procedures I can perform. If I could do a procedure less invasively to get the same results as a more involved surgery, I’d do it. Yet, non-surgeons and non-physicians market irresponsibly procedures with names and language implying if not outright claiming that they can get the same results with lasers and threads that you would get from a surgery like a facelift. There often are better ways to do things, but there are no shortcuts.

        Miracle treatments often lead to expensive complications
        Miracle treatments often cost people a lot more in the long run because of botched results requiring revision procedures

        Don’t assume that the doctor knows what you want and expect out of cosmetic surgery.

        When you consult with a very experienced surgeon, you might think, “Oh, he or she has done a lot of these procedures before, they’ll know what to do right away.” However, your situation is still unique to you, because your body, your face, your medical history is unlike anyone else’s, so communication is key. It is important that you are able to articulate what your aesthetic goals are, so that the surgeon may be aligned with those goals and develop a proper understanding of who you are, what is important to you, and what is motivating you to take this step.

        Communicate your aesthetic goals to your surgeon
        Communicate your aesthetic goals clearly to your surgeon to get the results you want

        Don’t assume that cosmetic or plastic surgeons are experts in every field of cosmetic surgery.

        Much in the same way that cosmetic surgeons and plastic surgeons practice separate and specialized disciplines, There are some surgeons who may be more focused on the eyes or face, while others may be more focused on body procedures. It is important that you seek out a cosmetic surgeon who specializes in the particular area that you want to have addressed. Going to a super specialist should significantly reduce the chances of complications and other undesirable outcomes.

        lower eyelid blepharoplasty complication done somewhere else
        Plastic and cosmetic surgeons are not specialists in every cosmetic procedure

        Don’t have unrealistic expectations.

        I have a core philosophy when it comes to cosmetic procedures: no one should be able to tell you’ve had a procedure. This means I enhance my patient’s appearance while retaining their character. You look like you; refreshed or well rested. I help my patients return to work typically in 1 week. I’ve made significant advances in the art of the procedures I perform, such as techniques to minimize bruising or swelling. I’ve made the sedation process easy to recover from and I get people back to work in typically one week. There is still a healing process which takes time to complete. Having realistic expectations as to the results and the speed of full healing needs to be well understood before having any procedure.

        Don’t have unrealistic expectations.
        Expect cosmetic procedures to make you look about 10 years younger, not several decades younger.

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          Do Under Eye Creams Work? Eye Bags Causes and Treatment

          Under eye creams cannot melt the fat that causes eye bags

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          The presence of eye bags is a common problem that affects people regardless of age, gender, or ethnicity. Eye bags are typically caused by genetics, as often seen in younger people, or age-related where fat around the eyes prolapses forward. The initial response of many people is to try under eye creams that claim to get rid of eye bags.

          Under eye creams cannot melt the fat that causes eye bags
          Under eye creams cannot melt the fat that causes eye bags, while leaving the lower eyelid skin unharmed.

          Eye bags can be seen at almost any age. I have treated three generations of the same family for eye bags. The youngest patient I treated was 14-years-old, and many people who come to me are in their 20s and 30s and have been aware of puffiness under the eyes since their teens.
          Under eye puffiness that’s always present, and makes one look tired and older is caused by a condition called lower eyelid fat prolapse. This means the fat normally around your eyes has pushed forward, creating a bulge, which is why it’s called lower eyelid fat prolapse, and also called herniated fat.

          Eye bags can appear in younger people
          Eye bags are a genetic issue, and not necessarily associated with aging, so even young people can have them.

          Lower eyelid prolapse differs from temporary causes of eye bags, such fluid associated with allergies, sinus problems, salt intake, and hormonal fluctuations. While these can all cause puffiness, they are usually intermittent. These temporary causes can also make the under eye puffiness due to fat appear worse.

          Creams which claim to eliminate under eye bags, don’t work because they cannot physically reach the deep fat pockets and have any effect. The best way to fully correct eye bags is through surgery to sculpt and remove the displaced fat pockets.

          Surgery is the only way to remove fat that causes eye bags
          Only surgery can sculpt and remove the fat that causes eye bags.

          While cosmetic eye creams can’t reduce eye bags, they can improve the quality, texture and color of skin under and around the eyes. I developed some skin care products which are designed for this purpose.

          There are basically two strategies to help improve the appearance of under eye bags. If someone has slight fat prolapse pushing forward, and has a certain anatomy of the bone structure under the eyes where there is space in the tear trough, fillers such as a hyaluronic acid filler in the Restylane or Juvederm family can be used to blend the transition between the elevation of the fat pocket and the hollow of the tear trough.

          Cosmetic fillers used to camouflage mild eye bags.
          Soft cosmetic fillers can camouflage mild eye bags.

          This approach to camouflaging lower eyelid fat with filler has been very useful in our practice to help patients with minimal fat prolapse and under eye puffiness.

          If someone has more severe eye bags, the more definitive treatment is surgical, called a lower eyelid blepharoplasty. Most general plastic surgeons perform this procedure with an incision in the lower eyelids, right beneath the eyelashes, and sometimes remove lower eyelid skin attempting to improve wrinkles.

          Transcutaneous blepharoplasty
          Transcutaneous blepharoplasty is the more common eye bag surgery, but is also more prone to complications.

          This approach is called transcutaneous blepharoplasty. I see a lot of patients who’ve had this procedure complaining of losing the shape of their eyes because the lower eyelid is pulled downward. I also see a number of patients who’ve had complications from this procedure like lower eyelid retraction and lower eyelid ectropion. These conditions result from skin shortage under the eyes and compromising of lower eyelid support.

          My procedure of choice is transconjunctival blepharoplasty. I feel this approach is a minimally invasive procedure that allows me to address under eye fat pockets surgically from the inside of the eyelid.

          Transconjunctival blepharoplasty method to remove eye bags
          Transconjunctival blepharoplasty involves no external incisions to remove fat, is less prone to complications, and looks completely natural.

          There is no external incision or effect on the supporting structures of the lower eyelid. I essentially reduce and reshape the fat to address the puffiness so you no longer have bags under your eyes while maintaining the natural shape of your eyes. The goal is to appear as if you never had bags under your eyes. This has been a highly successful procedure with faster recovery that allows my patients to return to work in about a week.

          No visible incisions after Transconjunctival blepharoplasty
          While still surgery, transconjunctival blepharoplasty is minimally invasive since it involves no visible incisions.

          We routinely perform this procedure under local anaesthesia with LITE® IV sedation in our Joint Commission-certified facilities in both our offices. For many patients who come to us from all over the world for this procedure, they like that they don’t have to go to a hospital or surgery center, and can comfortably have the procedure done, and go home soon after surgery. Not using general anesthesia makes patients more comfortable, and makes their recovery much faster since they are not recuperating from the effects of general anesthesia.

          patient look pretty good and return to work 1 week after surgery
          Dr. Prasad’s transconjunctival blepharoplasty procedure done under local anesthesia allows patients to look pretty good just a week after surgery.

          If eye bags are your concern, don’t waste money on creams. When you understand how the underlying lower eyelid where fat pockets which have prolapsed forward are responsible for these under eye bags, buying creams as a treatment doesn’t make sense. I recommend you meet with qualified and experienced cosmetic surgeons to learn about your options which are filler placement to camouflage, or surgery which is more definitive.

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            How Does Minoxidil Help Hair Growth?

            hair growth cycle

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            Minoxidil appears to work by affecting the length of the hair growth cycle. The hair growth cycle is comprised of specific stages: the anagen, catagen and telogen phases. The anagen phase is the active growing phase; the catagen phase is the resting phase when the hair is present but is not actively growing; and the telogen phase is when the hair sheds. During the telogen phase, there is a usually a 3-4 month time period before hair growth resumes.

            Scalp hair goes through growth, shedding, resting, and regrowth phases.
            Hair cycles include phases of active growth, shedding, resting, or regrowth

            When your hair is thinning or you’re experiencing hair loss, the length of time in the anagen phase decreases, and time in the telogen phase increases. This means you are losing hair faster than the rate of regrowth. When hair is thinning and the hair does grow back, it often grows back thinner.

            Minoxidil is an over-the-counter topical medication available under different brands names. Some medical practices offer higher concentrations of minoxidil in custom formulations.

            Minoxidil appears to help hair loss by prolonging the active growth period or the anagen phase, which means that the hairs that are progressively thinning grow for a longer period of time, and delays the hair from shedding or entering the telogen phase. This results in the hair remaining on the scalp longer before shedding. This effect of delaying hair shedding, and prolonging hair growth improves scalp coverage. Minoxidil does not block dihydrotestosterone or DHT which is often an important variable contributing to hair thinning in men who are sensitive to DHT. The benefits of minoxidil on the hair growth and shedding cycle decreases as hair loss continues.

            Hair Regeneration combined with finasteride works best for young men with high DHT-sensitivity
            Hair Regeneration can improve scalp coverage over finasteride alone, while finasteride can extend the effectiveness of the Hair Regeneration treatment in men with high DHT-sensitivity

            In our practice, we treat hair loss with a treatment system I developed, called TrichoStem Hair Regeneration. TrichoStem Hair Regeneration is a customized system I created by treating hundreds of patients from around the world with male and female pattern hair loss. I create customized treatment plans combining PRP (platelet rich plasma) with acellular matrix produced by ACell. Many of our patients who were previously using minoxidil are weaned off to avoid short term hair shedding. Since the first treatments performed in 2011, the benefits of TrichoStem Hair Regeneration have been sustained for 3-5 years with only 1 treatment session. Some patients with more advanced hair loss have a second treatment at 15-24 months. This second treatment which we refer to as “the booster” has been effective in thickening a large number of the thin hairs which were not visible and were reactivated by the first treatment

            6 months after hair regeneration treatment
            The TrichoStem Hair Regeneration treatment can thicken thinning hair and stimulate the growth of dormant hair follicles, without the need for minoxidil

            During hair transplant surgery, hair is harvested from the genetically resistant zone or donor area. Typically, a certain percentage of hair grafts don’t grow. In addition, in an FUE (follicular unit extraction) procedure, there’s a loss involved due to transection which occurs when the graft is harvested but the root is left behind. In FUE surgery, approximately 30% of hairs become transected, which means that those hairs don’t have a root and cannot grow.

            Hair Regeneration treatment can also help people who’ve had hair transplants
            TrichoStem Hair Regeneration can improve scalp coverage by thickening native hair, and improve coverage for people who previously had hair transplant surgery.

            Minoxidil can provide some benefit in helping men and women experiencing hair thinning. For men, finasteride is more effective as it decreases DHT (dihydrotestosterone) which allows more effective prolongation of the hair growth cycle. Finasteride is not generally effective for women with hair loss. TrichoStem Hair Regeneration treatment has been effective for both men and women with hair loss.

            Hair Regeneration treatment’s effect on female pattern hair loss
            The effects of TrichoStem Hair Regeneration treatment on female pattern hair loss after a single treatment session, and without minoxidil

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              5 Things to Consider Before Having Cosmetic Surgery

              cosmetic procedure risks are reduced by doctor's knowledge
              Can your cosmetic concern be addressed by a lifestyle change?

              During consultation, I often begin by asking about lifestyle with a focus on healthy habits. Some people find themselves focusing on aspects of their appearance without factoring in lifestyle related actions which can also help them look better. There are often certain cosmetic issues which can be improved with diet, weight management, exercise and skin care.

              ideal body weight for cosmetic procedures
              Cosmetic medical procedures are best done when within 10 pounds of ideal body weight.

              For example, someone who complains of excess fat under the chin or love handles may see a significant difference after a change of diet which results in weight loss. This is particularly relevant for people who are more than 10 pounds over their optimal body weight. In terms of procedures such as liposuction, ideal candidates are those who are within 10 pounds of their ideal weight.

              What do you really want?
               have clear and focused aesthetic goals
              Have clear and focused aesthetic goals before consulting a cosmetic surgeon.

              Make sure that your goals for cosmetic surgery are clear and realistic. In my opinion, the purpose of cosmetic surgery is not to change your looks, but to enhance your appearance in a natural way. If you’re concerned about the appearance of your face and looking in detail on a particular area of concern will more likely result in being able to express specifically what you’d like to address. This is more helpful to the doctor something like “I don’t like my nose.” Of course, I am asked daily by patients “Doctor, look at my face and tell me what you think I need.” I’m always ready to offer my perception as an to what features are more significant in terms of the overall facial appearance.

              Be clear and detailed with your doctor
              Be clear and detailed with your doctor about you want to improve. If your doctor suggests something, make sure you understand it clearly before deciding on it.

              Nonetheless, being able to articulate as clearly as you can what bothers you helps the surgeon gain a better sense of what you want to achieve and what issues are most important to you.

              Are you ready to make lifestyle changes?

              After cosmetic surgery, a healthy lifestyle will continue to support and maintain the benefits of your surgery. This can include adopting a good skin care routine, protecting your skin against the sun, watching what you eat, and eliminating unhealthy habits such as smoking and excessive alcohol use. Cosmetic surgery is an enhancement of the external appearance which can be optimally sustained by taking care of your health.

              lifestyle changes after cosmetic procedures
              Lifestyle changes such as reduced to minimal sun exposure are needed right after certain procedures, and to maintain results of most procedures
              What are the risks?

              Like any surgery, cosmetic surgery comes with some risks. It is important that you sit down with your surgeon and discuss all the possible outcomes of your procedure so you can fully understand the risks and benefits of your planned procedure. An experienced and safety focused surgeon can minimize risk. Each surgeon is an individual with experience in specific procedures based on training and practice.

              cosmetic procedure risks are reduced by doctor's knowledge
              There are risks to any cosmetic procedure, but they are reduced by the experience, expertise, specialization of the doctor

              For example, as an oculoplastic Surgeon, my training was focused intensively on cosmetic eyelid surgery which is in contrast to a general plastic surgeon whose residency is typically hospital based reconstructive surgery. Understanding what specific areas your prospective surgeon is most proficient in is in my opinion a good way to lower the risks of the surgery you’re going to have. There is (in my experience) no surgeon who is great at “everything” .

              Are you doing it for yourself or for someone else?
              happy after cosmetic procedures
              When choosing to do a cosmetic procedure, it’s important that the person you want to please most is yourself

              Cosmetic surgery is a very personal decision, and while there is no harm in asking for the opinions of close friends or family members, the final decision is ultimately only yours to make. Some people will undergo surgery because they feel pressured by certain people in their lives to look a certain way, or they’re trying to make someone else happy by changing an aspect of their appearance. As long as you’re excited about improving your appearance for yourself, your happiness is the only thing that matters.

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                Causes of Dark Under Eye Circles And How to Treat Them

                dark circles under eyes causes

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                Under dark circles are a fairly common problem that can affect people of all ages. There are several causes of under eye dark circles which makes it important to have the right strategy for your situation.

                Dark circles around the eyes can make people look tired and weary, even if they actually feel great, and have a lot of energy. Having dark circles can give the wrong impression about you and how you feel. In a world where first and lasting impressions are so important, it’s understandable why people are seeking all kinds of solutions for this common issue.
                man with dark circles under eyes

                Under eye dark circles can be caused by several issues:

                • Thin eyelid skin revealing the anatomy underneath the eyes such as the orbicularis muscle and blood vessels
                • Lack of fat and bone structure under the eyes resulting in a hollow look,
                • Ethnic pigmentation
                • Hyperpigmentation from previous procedures, such as laser treatment
                • Iron deposits from the blood circulation such as allergic shiners

                dark circles under eyes causes

                Popular strategies used by many people is the application of over-the-counter creams which make claims which they never live up to. While creams can moisturize the skin, they are limited in addressing any other anatomic issues which if addressed can result in more significant benefit. Upper and lower eyelid skin is the thinnest in the body at 0.5mm thickness when healthy. When eyelid skin becomes thinner from aging, sun exposure or smoking, the challenge is to improve the quality of the skin without compromising the thickness.

                man with obvious dark circles under eyes

                With this principle in mind, I have focused more than 10 years on the application of regenerative medicine technology, specifically platelet rich plasma or PRP. I use platelet-rich plasma, or PRP, routinely to treat several causes of under eye dark circles. Platelet-rich plasma is the concentration of wound healing and growth factors naturally present in your blood for when you have a cut.

                When concentrated, it can be used as an serum to improve skin quality, thickness, and overall skin health, while improving the blood circulation and blood supply in the area of treatment.

                dark circles under eyes treatment with PRP

                PRP is prepared from your blood, which is drawn in our office like you would have during a routine blood test. The blood is spun in a centrifuge to concentrate the platelets into a clear, yellow plasma, which can then be drawn into a syringe. The PRP is carefully placed under the eyelid skin. The regenerative process of this treatment is continuous, as increased blood supply and healing factors work after the injection to improve skin quality and thickness, stimulate collagen, and increased circulation.

                dark under eyes circles treatment with PRP and Filler

                In cases where the under eye area has concurrent hollowing, I can combine the placement of PRP with the deeper placement of a hyaluronic acid filler like Restylane to add volume. This combination treatment has a synergistic effect as both hollowing and skin quality are treated. For optimal, results, PRP is performed with regularly scheduled sessions. The frequency of these sessions depends on the conditions being addressed such as sun damage, wrinkles, and discolorations. PRP application helps change.

                dark circles undereyes treatment with CO2 Laser

                Lasers can also help with improving skin quality under the eyes, through resurfacing of the epidermis and collagen stimulation in the dermis. Lasers must be used carefully to avoid potential over treatment which can result in thinning of the under eye skin further, and possibly causing problems with pigmentation. When lasers used appropriately, they can be quite effective.

                I routinely combine PRP with laser treatments to reduce to create maximal synergy to achieve best results.
                PRP and Laser combined to treat dark under eye circlesDepending on the techniques employed, there is generally very little healing time with PRP treatment. Laser treatment for eyelid skin such as smooth eye long pulse erbium laser can be performed with no downtime. Fractional lasers such as fractional erbium or fractional CO2 laser may require a few days before the skin heals over.

                This means that most patients can go back to work right after PRP treatment and some laser treatments with basic precautions related to sun exposure and skin protection.
                A common question which comes up about every skin treatment is “how long will it last”. The answer is, it depends.
                Laser and PRP combined for optimal resultsThe collagen response of your skin is affected by age, extent of sun damage, wrinkling and pigmentation as well as your lifestyle such as smoking and amount of time spent in the sun. I evaluate every patient and develop a customized treatment plan for them based on these and other important variables.

                Dark circles can be treated without surgery, and results can really last. It’s important to note that ethnic pigmentation cannot be taken away, but you can improve skin quality so your eyes look more vibrant. As is important for any aesthetic procedure, knowledge and experience is important. In my experience, combining regenerative medicine technology such as PRP with advanced laser and radiofrequency technology has been successful for my patients.

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                  Pelleve Skin Tightening: A new procedure, with LI roots, in the war on wrinkles (Newsday)

                  There’s yet another weapon in the war on wrinkles.

                  Called Pelleve, the process uses radio-wave technology to induce heat into the skin, stimulating collagen growth to tighten skin and reduce the appearance of wrinkles.

                  The technology was developed by Ellman International, a medical company in Oceanside, N.Y., that got its start making equipment for dental surgery.

                  Pelleve was granted FDA approval as a facial wrinkle reducer in May 2009, said Tom Harper, vice president of global marketing at Ellman. The equipment was initially used to stop bleeding during surgery, said Harper, adding that the treatment is now being used in well over 200 facilities in the country. “Patients seem to feel there’s a lot of value in the product, especially around the eyes and jawline,” he said.

                  WHAT TO EXPECT The doctor or technician will apply a protective gel, then run the handpiece over the area being treated. Patients generally report feeling a sensation of warmth. “It goes to a point where it feels very hot,” said cosmetic surgeon Amiya Prasad, one of several Long Island doctors using the treatment. “Most people tolerate it very well,” he added. No numbing or anesthesia is required (or desired since they want you to speak up if it gets too hot).

                  DOES IT WORK? “Pelleve has worked out to be a good service for our patients, for the person who is not quite ready for a face-lift,” Prasad said. Likewise, Greenvale dermatologist Deborah S. Sarnoff says patients have been happy with the procedure, which she often combines with Botox and fillers. “A Pelleve treatment is administered to improve overall skin laxity,” she said, “then I inject filler to areas that may need more volume and Botox to relax the dynamic wrinkles.”

                  Sarnoff says that, unlike other treatments, “patients see an immediate improvement,” though many doctors suggest two or three sessions for the best results.

                  HOW’S IT DIFFERENT? Pelleve differs from Thermage, another procedure that uses radio frequency, in that the handpiece can be moved back and forth over the skin, which doctors say allows them to more easily target problem areas.

                  COST Harper says costs vary widely. In this area, treating the entire face runs $1,500 to $2,000 a session; treating a single area (like the eyes) can run $500 to $1,000.

                  WHO SHOULD HAVE IT? Both Prasad and Sarnoff say the ideal Pelleve patient is someone with mild to moderate wrinkling or skin laxity, or someone who had a face-lift and wants to maintain the results.

                  By Barbara Schuler; Newsday, Tuesday, October 19, 2010

                  Pelleve Skin Tightening Amiya Prasad MD