Lower Eyelid Surgery FAQ Videos

When dealing with the tear trough area, a few factors must be taken into consideration: (1) skin thickness, (2) skin color, (3) bone structure, and (4) the presence or absence of fat pockets. If there is no presence of bulging fat pockets in the general area, Dr. Amiya Prasad opts for a dermal filler, such as Restylane, and platelet-rich plasma (PRP), in order to improve volume and skin quality.

Eye bags are essentially fat around the eyes that have become saggy and displaced. Though there are a number of eye creams and cosmetic treatments and facials that claim to get rid of eye bags, they don’t work on the internal fat pockets. Blepharoplasty is required to remove and reduce the fat pockets that cause puffy eye bags.

As an Oculofacial plastic surgeon with over 20 years of experience, Dr. Amiya Prasad has seen to many corrective surgery cases, and has noted that eyes can look tired because of droopy eyelids and puffy under eye bags. He emphasizes the fact that eye surgery, if done poorly, has a serious effect on the function and health of the eyes, and thus it is vital that patients meet with a very experienced surgeon who specializes in that particular field. It is easy to be won over by notable terms like “Board Certified”; however, this term alone is not indicative of any specialized training or expertise in the area. Dr. Prasad recommends that patients do thorough research first before undergoing any kind of surgery.

Oculofacial plastic surgeon Dr. Amiya Prasad performs blepharoplasty with the use of his intravenous LITE™ IV sedation method—a technique that places patients in a relaxed, but still conscious state. This type of sedation method has been proven to allow patients to recover from surgery much quicker than they would had they been placed under general anesthesia.

During an upper eyelid blepharoplasty procedure, problems with the eyelid crease and extra skin on the eyelid are addressed. Other cases may also call for fat sculpting around the eye area as well. A lower eyelid blepharoplasty procedure addresses the problem of eye bags, and can be done from a transcutaneous (outside) or transconjunctival (inside) approach. Be sure to seek out a surgeon with superior eyelid surgery skills, as poorly done eye surgery can lead to other complications.

The risks of eyelid surgery can include the following: (1) bleeding, (2) infection, (3) drooping of the upper eyelids after surgery, (4) skin shortage that prevents full eyelid closure, (5) unwanted scarring, (6) lower eyelid retraction, (7) ectropion, (8) dry eyes and, (9) corneal ulceration. Be sure to have a complete medical and physical evaluation of your eyes before undergoing surgery, to prevent the risk of developing complications. A proper examination should include a proper diagnosis of any existing eye issues, such as ptosis or lacrimal gland prolapse.

Post-surgery scars can be avoided with (1) detailed planning, (2) minimally traumatic surgery and, (3) immediate post-operative care.

Dr. Amiya Prasad prefers the transconjunctival approach when performing a lower blepharoplasty, as it is less traumatic and leaves no external incisions on the skin. For upper blepharoplasty, Dr. Prasad employs his artistic eye when planning where to place the incisions in such a way that will be barely visible, even when the eyes are closed. After surgery, Dr. Prasad employs a suturing technique and administers platelet-rich plasma (PRP), in order to accelerate the healing process. This combination, along with proper home aftercare, has helped patients recover quicker with less scarring.

A transconjunctival blepharoplasty is an eye procedure that addresses the problem of puffy-looking eyes from an entry point on the inside of the eyelid. This is often Dr. Amiya Prasad’s procedure of choice, as it does not leave any external scars and also preserves the delicate muscles and ligaments that provide support and function for the lower eyelid. A transconjunctival blepharoplasty may be combined with other treatments like microfractional CO2 laser treatments and platelet-rich plasma (PRP) to treat under eye wrinkles and dark circles.

The effects of eyelid surgery can last between 5-10 years, given the following circumstances: (1) the patient’s age at the time of the surgery, (2) the patient’s overall health, and (3) the state of the patient’s skin. Oculofacial plastic surgeon Dr. Amiya Prasad makes it a point to manage his patient’s expectations by helping them gain an understanding of how our faces age over the years and how this can affect the results of surgery.

When preparing for eyelid surgery, it is important to disclose the following information to your surgeon: (1) your overall health status and whether you have any prevailing conditions or ailments, (2) if you are taking any prescription medicine or supplements, and (3) if you have or had any eye ailments such as dry eyes or blepharitis. It is vital to address these conditions first before undergoing surgery in order to prevent any complications during surgery. Keep in mind that the more thorough you are about your medical history, the more favorable it will be for both you and your surgeon.

Some common complications patients may experience are the following: (1) droopy upper eyelids, (2) skin shortage that hinders the eye from closing properly, (3) lower eyelid scleral show, (4) lower eyelid retraction, and (5) ectropion. In order to steer clear of complications like these, pursue the services of a surgeon who concentrates on this type of eye surgery, as you can be assured that he will have a deeper and more extensive level of training and specialization in the field. Pursue a surgeon who will also be committed to understanding your own aesthetic goals, as well as the kind of results you hope to see.

Doing research is the best way to find yourself the right doctor for your case. Because eye surgery is a very complex practice, it most definitely necessitates skills and knowledge that most general surgeons simply do not possess; thus it is essential to look for a specialist with the proper training background and area of expertise. The amount of experience a doctor has is another important value to take into consideration. As a cosmetic Oculofacial plastic surgeon with over 20 years of experience, Dr. Amiya Prasad makes it a priority to educate patients about eyelid surgery so they can make more informed decisions.

“Pulled down” eyes—also called “rounding”, “scleral show” or lower eyelid retraction—commonly happens in certain patients after a blepharoplasty procedure and is triggered by tissue loss, leading to poor support of the lower eyelids. Specialized revision surgery can be performed to fix this type of problem. The surgeon will inspect the anatomical relationship of the patient’s eyes, and then establish an ideal position for the eyelids. Keep in mind that before corrective surgery can be performed, proper eye lubrication must be maintained at all times, especially on the exposed areas. This will keep infection and irritation at bay and will not complicate the surgery.

Under eye bags are not directly influenced by sleep patterns. Rather, they are triggered by something called “lower eyelid fat prolapse”, which is when the fat around the eyes is displaced, making the eyes look extra tired. Most people turn to eye creams with the hope of getting rid of their eye bags, however, these creams can only improve the exterior quality of the skin around the eyes and do not address the root cause of the problem which is fat prolapse.

Practicing Oculofacial plastic surgeon Dr. Amiya Prasad chooses to use his own method of sedation for surgical procedures—LITE™ anesthesia. LITE™ anesthesia stands for “local”, “intravenous”, “tumescent/twilight” with “ease of recovery”. This type of sedation method places the patient in a tranquil state, while still being conscious during the procedure. In Dr. Prasad’s experience, this technique is less taxing on the body, as opposed to general anesthesia wherein the patient is completely unconscious and placed on a ventilator.

The formation of keloids in darker skinned individuals can be avoided if extra precaution and care are given. In his article, “Ethnic Considerations in Eyelid Surgery”, Dr. Amiya Prasad says that a good understanding of the skin type, facial anatomy and optimal placement of incisions on darker skinned people can help prevent the formation of keloids. Thus, it is advisable to seek out a surgeon with significant familiarity in treating darker skinned people and allots the needed time to fully evaluate and understand a patient’s case.

Because downtime after surgery is often viewed as an inconvenience, Dr. Amiya Prasad established his own system of treatment that helps patients recover faster, with less downtime. It starts in his Joint Commission-accredited operating facilities, wherein he performs all surgeries with the assistance of an efficient team of nurses who he works with consistently. Years of experience have shown that the convenience of working in your own private facilities with a team you’re familiar with makes surgical procedures run faster and smoother. When surgery is done, immediate one-on-one aftercare is given, which also plays an important role in helping patients recuperate faster. Patients are usually able to return to work within one week.

As an Oculofacial plastic surgeon, Dr. Amiya Prasad repeatedly comes across dry eye cases and has successfully performed eyelid surgery on many severe dry eye cases, and even on patients with Sjogrens Syndrome, rheumatoid arthritis and thyroid eye disease. Before having eye surgery, patients are evaluated and examined in order to determine the best position for the lower eyelid, which will better facilitate the proper lubrication of the eyes.

Creams cannot resolve the issue of under eye bags, because the root of the cause—lower eyelid fat prolapse—is not being addressed. The best that eye creams can do is improve the skin’s quality, texture and color. In order to address eye bags, surgery is needed to sculpt and reposition the displaced fat layer under the skin.

Blepharoplasty only addresses eye wrinkles that are part of the extra skin being removed during the procedure. Otherwise, blepharoplasty can do little to remove wrinkles. There are other options that patients can look into, depending on the type of wrinkles they have.

Platelet-rich plasma (PRP) and microfractional CO2 lasers can address static wrinkles, which are wrinkles that are seen on the face even without muscle activity. Botox® and Dysport, on the other hand, can address dynamic wrinkles, which are wrinkles that are caused by facial expressions such as smiling or frowning.

Increasing the amount of collagen under the skin is the best way to treat under eye wrinkles, and most of the time, patients achieve this by undergoing thermal stimulation of the under eye skin. It is important to remember that under eye skin is especially thin and sensitive compared to the rest of the skin on your body. It is therefore essential for your attending surgeon to adjust and customize his approach to heat treatment to suit the individual.

In his practice, Dr. Amiya Prasad uses the microfractional CO2 laser on light-skinned patients, and Pellevé radiofrequency treatment on darker skinned patients. Dr. Prasad also administers platelet-rich plasma (PRP) alongside the treatment to further help boost the collagen formation.

The rate of success of ptosis surgery is determined by the following:

(1) The type of surgery
(2) If other surgeries are performed alongside it
(3) The type of anesthesia used
(4) The surgical team
(5) The surgical technique
(6) The post-operative recovery process

Dr. Amiya Prasad has developed his own sedation technique specifically for his practice. This technique—LITE™ IV sedation—allows patients to emerge from surgery feeling more refreshed than they normally would had they been given general anesthesia. This type of sedation technique also lessens the post-surgery downtime experience.

In order to keep surgical procedures running smoothly, Dr. Prasad chooses to work in his own Joint Commission-accredited operating facilities with a consistent and tight-knit team of highly proficient professionals. Working in such a set-up makes everything enormously convenient for both surgeon and patient, as they are able to give patients the immediate care they need, which ultimately leads to a better recovery experience for them. With this kind of attentive care, most people are able to work again after 5-7 days.

Dr. Prasad asserts that with any type of surgery, technical expertise, experience, and an artistic eye are indispensable. Mastery of these techniques and exposure to different cases contributes to a surgeon’s ability to make more accurate decisions and improves the way he responds to different scenarios.

Due to financial interests and competition, some surgeons have been known to engage in inter-specialty rivalry, claiming superiority over other groups of surgeons, and even overselling the term “Board-certified surgeon” in an effort to market their own practices.

As a practicing Oculofacial plastic surgeon with over 20 years of experience, Dr. Amiya Prasad consistently entertains patients from all over the world who seek corrective surgery for improper surgical jobs done elsewhere. Based on his experience, quite a few of these bad surgery jobs are often performed by general surgeons touting the “Board-certified” label. Dr. Prasad asserts that the “Board-certified” label is not entirely indicative of a surgeon’s technical abilities, proficiency and artistry, and that there will always be inconsistencies. With that in mind, it is important for the patients to do their own research and seek out a surgeon who specializes in the type of surgery they are considering and will spend time understanding their case, as well as their aesthetic goals.

Eyelid lifts are performed to remove, improve, or sculpt extra skin and fat around the eyelids, while blepharoplasty is performed on the upper and lower eyelids to address extra skin, fat, and other structural issues. A patient can choose if they want to undergo either an upper or lower eyelid blepharoplasty, or both. Ptosis surgery, on the other hand, is a procedure specifically designed to fix the orientation of the eyelid margin in relation to the pupil. Other specific ptosis procedures may also incorporate levator muscle advancement, levator resection, and frontalis sling.

Transconjunctival blepharoplasty is a surgical procedure that addresses the problem of puffy or bulging under eye bags by accessing them through the inside of the eyelid. The advantage of this method is that it leaves no signs that you’ve had cosmetic surgery done since cuts are made on the inside of the eyelid. Another favorable feature of this procedure is that a person’s natural eye shape is better preserved.

Blepharoplasty is an upper and/or lower eyelid surgical procedure that is designed to improve the look and function of the eyes, and to address extra skin and swollen fat pockets around the eyes.

Dr. Amiya Prasad, a committed Oculofacial plastic surgeon with 20 years of experience, emphasizes the significance of performing blepharoplasty with not only a deep understanding of eye health, but as well as the importance of having the technical know-how to successfully realize the main objectives of the surgery.

Many of Dr. Prasad’s clientele come to him to get corrective surgery for procedures that were inadequately done by other surgeons. He attends to patients in his Joint Commission-accredited operating facilities, normally using local anesthesia with intravenous (IV) sedation. Within a week, most of his patients are able to return to work without feeling too much pain.

Some complications that may arise during blepharoplasty are: (1) excessive bleeding, (2) infection, (3) unwanted scarring, (4) vision loss, and (5) double vision.

Keep in mind that matters such as extra skin and sagging fat pockets around the eyes do not typically fall under the category of “complications”, and are considered “enhancements”. Dr. Amiya Prasad often performs such enhancements on patients pursuing corrective surgery to fix unsatisfactory results from an earlier surgery done by another surgeon. Most of the time, the most frequent reason why people get revision surgery is to address retraction of the lower eyelid, which is a complication wherein the lower part of the eyes becomes exposed and irritated. It is best to seek out a surgeon who specializes in such cases in order to understand the best approach for treating it.