When it comes to facial aging, it’s common to think of wrinkles, sagging skin, and the
skin looking dull having lost its youthful glow.
It stands to reason why a lot of people focus on what they see - their skin.
This often results in frustration with creams and skin tightening procedures because what’s
being overlooked is the loss of volume in the bone structure and soft tissue which is
well below the skin.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Facial aging and the strategies to help people look better at any age has been a major part
of practice throughout my career.
My approach to helping my patients based on a problem based strategy.
I developed this approach as a response to help people who came to me frustrated with
results after being treated by both surgeons and non surgeons.
Recommendations made by physicians and non physicians is often based on the limitations
of scope of knowledge and experience as well as bias toward directing patients toward a
specific procedure.
As a surgeon, I recognized that I could help my patients with a lot of new products and
procedures from a perspective that many of my colleagues don’t have generally choose
not to develop.
I recognize how people are constantly being directed toward so called “revolutionary”
and “miraculous” solutions from profit driven agendas with no concern about providing
people with education and comprehensive strategies.
Essentially short term transactions take priority without any concern for long term consequences.
I applied my knowledge and experience performing procedures such as facelift and cheek implants
to non surgical solutions such as injectable fillers resulting in highly successful results
which meets our patients’ needs in the modern world.
I routinely spend a lot of time providing my patients with education so they have a
full understanding of their individual situation and make my recommendations to maximize their
results with safety, predictability and quicker recovery.
There are 5 general areas of concern which draws attention with facial aging
Fine lines and wrinkles The perception of deeper lines such as the
nasolabial folds and marionette lines Loss of definition in the cheeks, jawline,
chin Thinning of the lips and lines around the
mouth Drooping of the eyebrows and eyelid skin as
wells puffy looking fat pockets in the upper and lower eyelids.
Fine lines and wrinkles can represent a loss of skin quality from loss of collagen in the
skin as well as fat and support under the skin.
More significant is the effect of facial volume loss, particularly bone and soft tissue.
This level of loss is comparable to losing the foundation and framework supporting a
building.
As the foundation collapses, the outside fold inward resulting loss of projection and deepening
of lines and wrinkles.
Often time people perceive that the solution is to do something to tighten the skin.
When you look at a younger face, you know that a youthful face is not tight.
A youthful face is characterized by volume and a balance of proportions.
The angles and soft cushioned appearance of the skin also contribute to the perception
of youth.
Age related loss of volume occurs slowly.
If you look at pictures of yourself in your early 20s, and look at pictures of yourself
in your late 30s to 40s, you may be able to appreciate how volume loss affects your appearance.
This facial volume loss is again due to loss of bone, muscle, fat, and soft tissue.
Bone loss is particularly important since loss of even a few millimeters of bone results
in a significant loss in facial volume.
During consultation with my patients, after I educate them about facial volume loss, I
discuss a strategy to improve their appearance from the inside - out.
By inside, I mean improvement of volume at the bone level, followed by the soft tissue
above the bone and finally outside to the skin level.
As a surgeon, restoring facial volume in the past was approached by the placement of facial
implants.
I would use different size cheek and chin implants to restore volume in these respective
areas.
I also used to perform volume augmentation with fat grafting.
This procedure involved harvesting fat with liposuction, processing the fat and then placing
the fatty tissue under the skin.
These procedures did come with advantages and disadvantages which were discussed with
my patients prior to surgery.
These procedures were the best options in the past due to the limitations of the fillers
available at the the time.
In the past several years, there has been significant advances made in filler technology
particularly in hyaluronic acid fillers.
In particular, certain hyaluronic acid products are more substantial and last for more than
1 year.
The ability to precisely and predictably place longer lasting fillers at the bone level and
the levels below the skin with minimal recovery time created changed the way I approached
facial aging.
Interestingly, restoring facial volume can also have a lifting effect.
A certain percentage of sagging of the skin is from the loss of support resulting from
bone and soft tissue loss.
Restoring volume has a lifting effect as the added volume supports the skin and soft tissue.
Facial fillers are very popular amongst many doctors.
However, technique and experience are critically important in achieving natural results.
Most doctors inject facial fillers at the soft tissue level of the face which is right
below the skin.
When filler is placed at this level, the shape the filler takes can make the look soft and
doughy and even swollen.
This has become commonly referred to as a “pillow face”.
which does not in any way resemble the firm, structured facial volume of a younger face.
I perform facial filler placement with techniques which are performed by few doctors called
Structural Volumizing.
Placing filler at the bone level below the facial muscles puts volume where its needed,
at the foundational level.
The resulting shape creates better definition to the face instead the soft and rounded look
seen so commonly seen.
Placing filler at the deeper level of the bone structure under the the muscles with
minimal trauma is technically challenging.
As facial cosmetic surgeon who performs facelift and facial implant surgery, I know this anatomy
very well.
I do see patients for corrective work or revision who previously went to physicians and non
physicians who lack this type of experience and understanding.
Part of my approach is place fillers with instruments such as blunt cannulas instead
of needles.
Blunt cannulas cause less trauma to the skin, soft tissue, and muscle, so bruising is minimal
if at all.
This strategy of Structural Volumizing can be applied to the cheeks, brows, temples,
tear trough, mid-face, jawline, and chin.
Volume loss at the mid face and lower face causes deepening of lines around the nose
and mouth, known as nasolabial and mesolabial folds.
commonly referred to as smile lines, laugh lines, and marionette lines.
Structural volumizing of the midface and lower face restores balance with the upper face.
In addition, restoring soft tissue volume and application of neurotoxin can change the
look from aged and tired to youthful and friendly.
As volume is lost in the jawline, particularly in an area called the mandibular notch, the
continuity of the jawline accentuates the appearance of jowls.
Placing volume in this area can give the jawline more continuity and definition, resulting
in significant improvement of jowls.
In addition, the chin typically loses projection with age.
Structural Volumizing can restore projection to the chin, and can be placed in a way that
resembles the shape of a chin implant creating smoother continuity with the jaw.
At this time, I use longer lasting hyaluronic acid fillers for Structural Volumizing such
as Juvederm Ultra Plus and Juvederm Voluma.
These fillers can last up to two years, before they are gradually and safely metabolized
by the body.
As far as recovery from a procedure is concerned, there is minimal swelling from a small amount
of local anesthetic and most people go back to work the same day or the next day.
This procedure has been very helpful for my patients who need to look good on short notice.
Events such as weddings, birthdays and reunions inspire a lot of my patients to come in and
do this procedure.
As a routine, I see patients after two weeks to see how everything has settled.
This is a time when an enhancement can also be done for subtle improvement.
The effects of Structural Volumizing can be dramatic and restore appearance with confidence
in a few minutes.
This has been an ideal procedure for people who come in thinking that they need a facelift,
but in reality are better candidates for volume correction.
This type of volume enhancement has a remarkable impact on the face without surgery.
I hope you found this information helpful...thank you for your question