So here's somebody who has hollowness in this area, clearly, but also will say I have dark circles. because of the pigmentation. So this is an area where we can do something that's very effective, and that is to treat a hollow.

So this area right here is called the tear trough. Now this person also happens to have a little under eye puffiness, but what I did was I placed a little bit of hyaluronic acid in this area to soften the contrast.

And by doing that, you don't see it as a dark circle as much. Now it looks softer and it blends in very nice. So this was done with the hyaluronic acid filler.

It takes a few minutes done in the office and can last six months to a year, sometimes longer. This is Doctor Talks, real talk from real doctors on the issues that matter to you most.

This episode was recorded during the Eye Health Summit, where the world's leading experts shared breakthrough insights in vision and holistic eye care.

Hello, everyone. I'm your host, Dr. Rani Banak, and today I'm so excited to introduce Dr. Amiya Prasad, a renowned expert in oculoplastics. Dr. Prasad specializes in addressing age-related eye changes and helping patients achieve a more youthful appearance.

Oh, it is absolutely my pleasure. Thank you for inviting me. I'm very excited. I think this is a great thing you're doing as a public service to share knowledge and information to as many people as possible.

So this is great. Thank you. Oh, and thank you for those kind words. And for the audience, I just want you all to know that Dr. Prasad and I go back a very long ways.

And just on a personal note, Dr., our moms were best friends. We knew each other growing up. And Dr. Prasad went into ophthalmology, and he was actually the person who introduced me to this amazing field.

So I would not be where I am today without Dr. Prasad. So I'm forever grateful to you. Thank you. Thank you so much. I'm so glad it worked out so well.

Ophthalmology is an amazing field and I think we both have found our places in our specialties and it's awesome. It's really nice to be able to have this journey the way we've had it so far.

So thank you. Absolutely. So let's just begin by asking about your journey because you started off as an ophthalmologist, but then you did additional training in oculoplastics.

Why did this particular area of ophthalmology interest you so much? So it's interesting because ophthalmology has so many amazing aspects to it. And you make such an impact on people's lives by helping them with their vision.

During my residency, I happened to work at a level one trauma center. And that meant that there was a lot of opportunity to do reconstructive surgery.

And because plastic surgery is such interdisciplinary specialty, people had trauma that involved their eye, involved their face. And so there was a certain art and creativity that appealed to me.

And I've always been creative and artistic. And so I always loved to draw and I loved photography. And so it really merged very well. And of course, I, to this day, 30 years, more than 30 years in practice, The most beautiful part of the face is the eyes.

So it's incredibly inspiring. And so it was very straightforward. I loved oculoplastics and so I was lucky enough to get trained in it. Well, thank you for sharing that journey, Dr.

Prasad, and I have to say you have certainly found your calling. I've sent many patients to you and they've come back very, very happy and grateful with the work that you've done.

So you're a very, very skilled surgeon. So let's begin with talking a little bit about age-related changes around the eyes. First of all, why are the eyes so important when it comes to our appearance, our looks, our self-esteem?

Why is it such a critical aspect of our identity? Well, the eyes are very important in that there's not only the appearance, but there's the functional aspect of the eyes.

But if I may, I'm going to share my screen and show you a couple of things that I think will help answer this question. So we all make eye contact. That's how we communicate.

Since we're babies, eye contact is so important. And what is particularly relevant is that it's reflected in how people behave. So the global eye skincare market is multi-billion.

People think about caring about the appearance of their eyes. The eye makeup market, you see it, it's only rising. It's people know instinctively that how important eyes are.

And then when we look at it from the perspective, when we make eye contact, it is fascinating when you ask the question, how long does a first impression take?

And the answer to that question is that it takes one-tenth of a second. Wow. An amazing study published, I believe, in 2006 by Alexander Todorov said that we make up our minds about others after seeing their face for a fraction of a second.

And it just so happens a fraction of a second or a tenth of a second is the same time of a blink of an eye. So it's very, very important that our eyes reflect how we feel.

This is a fascinating study which showed where do we look when we meet people, when we look at their face. The hot spots are the eyes. Wow, that was truly eye-opening, pun intended.

I never truly thought of it like that. I mean, I think instinctively we all look into the eyes of the person we're speaking with, but we don't realize the depth of the implications that that first look has on our impressions.

So thank you for sharing that amazing information. So Dr. Prasad, there are many changes that can happen to our eyes as we age. It's an inevitable part of getting older.

We're going to be talking about just a handful of them, and I'd love for you to share, you know, what are some of the top things you see in your practice as an oculoplastic's doctor when it comes to age-related eye changes?

And we can talk about each one more in detail. Sure. Well, to summarize it simply, people don't like looking tired. In fact, very much of how we feel is connected with how we look.

So the common issues, bags under the eyes. Patients will always say, people keep asking me if I got enough sleep. When your eyes are hooded, they may look tired.

When you look at someone's eyes, inherently there's a beautiful characteristic shape to those eyes. But when the eyes are so hooded that you don't see that shape, then the hooding defines the shape of the eyes.

Then there's a condition that is common and underappreciated called elliptosis. naturally people look sleepy and now a lot of times people are born with it and a lot of times they may have a mild ptosis but as they get older the drooping of the eyelid becomes worse.

So I'll just show a couple of examples of what I've described. So this is the classic under eye bags and no matter how Well-dressed you are. Bags under the eyes are just conveying that I'm tired.

Let's go to the next one. Hooded eyes. When someone can't see her eyes. I mean, this is very advanced, but we're talking about aging. So that's where it can progress to.

Now this is really interesting because this is something that's underappreciated. Plastic surgery oftentimes overlooks the presence of eyelid ptosis. And so people can have eyelid surgery, but you notice in this individual, there's not a lot of hooded skin, but yet their eyes look tired.

And so that's important. Just go to the next one. Of course, you don't have to have just one. You can have a combination where you have hooded upper lids and you have bags under the eyes.

These are all very common age-related changes. Of course, we understand that lines and wrinkles are part of life, and that's okay. There's a balance that is individually determined as to how much it takes away from their appearance.

Then there's skin textural changes. So you see these fine lines and wrinkles that are associated with sun damage and with sun exposure. And so wrinkles and lines around the eyes are also very, very common concerns.

But that's essentially the overview of those most common concerns. Thank you for sharing those images. I think many of us have either experienced some of those issues or definitely as a provider, I've had countless patients come in complaining of looking fatigued or their eyes droopy or sagging or having these wrinkles and fine lines.

It is part of aging, but there are many options now that patients may consider to help manage these symptoms. Let's dive a little bit into first, let's talk about those fine lines and wrinkles.

What are some, the range of options people have to address those specific types of concerns? Right, and that's the key word is range. There's a lot of opinions about different aesthetic treatments, and everyone has celebrities and people that they point their fingers at.

But we always have to define the solution by defining the problem. So there are two types of wrinkles. There's static, which means lines that are there at rest, and there's dynamic.

So what we do is we look at people and say, all right, let's start with symbol. Okay. What happens as we, the lines form, we're losing collagen. Collagen is a protein.

And although lots of people drink collagen, hoping to replace collagen, the most basic Reality is that the digestive enzymes break down the collagen you drink and you don't necessarily deposit collagen It's really not I mean have lots of protein in your diet, but the collagen supplements Yeah, I know and yet, you know people wanted we will want to take action So I don't fault anyone for trying but we lose 1% of the collagen in our skin every year from the age of 20 to 25. So you can imagine that that can be significant.

And it leads to the loss of the foundation of the skin. It collapses and you get some of these lines. Again, we don't aspire to have just flawless porcelain skin, but the simplest thing to do is to start with skincare.

And so we offer different creams, basically a good moisturizer, a sunblock, and something for cell turnover. It's like a good, basic, minimal thing you can do.

Going beyond that, where we have fine lines and wrinkles around the eyes, we can do more aggressive things. Like this is an example of someone who had eyelid surgery, which is blepharoplasty of the upper lids and the lower lids.

And you can see how much smoother their skin looks because I used a fractional CO2 laser. And so it refreshes the skin and you get this fresh new baby skin.

And it takes about a week to recover from, so it's not too disruptive. And you can get a really nice outcome. I have to say, she looks about 20 or 30 years younger than Rory.

Yeah, no, that's absolutely right. Because again, the eyes have such an impact. Now you can see the beautiful blue color of her eyes and the quality of the skin being so much fresher.

And I'll tell you, you know, Again, psychologically, when we look at ourselves and we like what we see, we feel more confident. And that permeates everything in our lives, our relationships.

It's great. And so for people who maybe don't have downtime or want just to treat fine lines, we actually have no downtime lasers like this example where we did something called Smooth Eye.

And you come in once every four to six weeks for a few sessions and the skin tightens because new collagen is being created as a response to the stimulation of the skin with the laser.

So now we get two wrinkles that occur because of activity. We call that dynamic wrinkles. And that has to do with the activity. And when you think about it, if you're creasing the skin from the activity of the muscles, you're going to make those creases more deep.

So we're all familiar with the number one non-surgical treatment in the world, Botox. And Botox is in the category of medications that are called neuromodulators.

And neuromodulators essentially relax muscles. The stereotype about Botox is you don't have expression. That's not the Botox's fault. It's the practitioner and the patient who decided that that looks good.

But you look very natural, and this is art. And there are other competitors, Juveau, Dysport, Xeomin, that have been very, very effective. So this is an example of showing that this woman is smiling and contracting, but when with the Botox on board, it's not as emphasized.

You could still smile, you could still be expressive, but you're not deepening the lines. And this example is really good because she's doing almost exactly the same expression in the second picture, and yet she doesn't cause the breakdown of collagen as we get older from the repeated deep creasing.

So again, it's art, like everything else we do. Well, thank you for sharing those images, Dr. Prasad. It's so helpful to visualize what you're talking about because people may think, you know, maybe it's not so bad, but then when they see these photos, they can really relate to it and now know that there are multiple options out there.

I think when people think of wrinkles, they immediately think of Botox as the one and only, but it's wonderful to know that there are several different options that people may want to pursue.

The next very common condition that many of my patients come in with are kind of like eyelid bags, which I think you showed some images of those, or upper lid kind of puffiness and drooping.

Can you tell us a little bit more about how to best manage those types of issues? Sure. So we'll start with topic of drooping eyelids. And no one has to learn these, but what I want to echo about what you just said is that people have so many options.

And we live in a time where information is plentiful, but there's a difference between information and knowledge. And so meeting with a practitioner who is going to help you navigate is critically important.

And so when I see my patients who come in with, let's start with drooping eyelids. Drooping eyelids can be too much skin, like over here, or it can mean the eyelid is drooping lower than it normally is.

And so we refer to those conditions as dermatocalasis and ptosis. So when we look at somebody, and this is actually kind of a view into how I do my evaluation.

We see drooping eyelids, dermatocalasis, so it's excess skin. Now if I ask myself about whether or not somebody has just excess skin, we can evaluate it further, but that's a start.

And so when we have only excess skin, we can do something called an upper eyelid blepharoplasty. When we do an upper eyelid blepharoplasty, you can see there's a reveal.

There's a reveal of the true shape of her eyes. This lady has beautiful eyes. And although hooded eyes can also be beautiful, but when they're obscuring the natural shape of the eyes, it is no question that she looks better afterwards.

She looks more awake and she looks natural. If you were to see that second photo, you'd never think that she had eyelid surgery. And that's another common concern is people don't want to look like they had surgery.

Now, again, in evaluating drooping eyelids, and I see there's dermatocalasis or the extra skin, what I do is I lift the eyebrows. And when I lift the eyebrows, I look at the eyelid height.

And when I look at the eyelid height, you can see this eyelid is kind of low. So not the ebby skin. only responsible for the position of the eyelid, but also the actual muscle that lifts the eyelid called the levator muscle.

So when we understand that, the cosmetic surgery can be that much better. So with this lady, I took care of the hooding of the upper eyelid, but I also addressed the ptosis.

And this way, she had a nice, balanced, symmetric look, and is very happy. And again, looks natural. Wow, those are some incredible illustrations of how effective some of these interventions can be and give people a more refreshed look.

And the other part of it is when the eyelids are heavy, whether it's excess skin, dermatochalasis, or whether the lid is actually droopy, it also affects our vision.

Right, Dr. Prasad? We're not able to see some of our world up above because our eyelids are obscuring our vision. So there's a cosmetic aspect, but there's also a functional aspect to some of these procedures you're doing.

Absolutely. In fact, the feedback I get is that patients feel like they can just see more. The world looks brighter. And they weren't aware of this, but they're raising their eyebrows all the time and they get tension in their forehead from constantly raising their eyebrows.

So there's a lot of quality of life that's also improved and not only the confidence that comes from having nice, natural looking eyes. Well, thank you.

Yes, that is so, so true. Well, Dr. Basad, this has been such an enlightening conversation. We are going to take a very short break from one of our sponsors and we will be right back.

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One of the very common things that I see in my patients is many of them complain of bags or puffiness under their eye or even really heavily pigmented areas, which we know as dark circles.

What are some potential solutions for those kinds of eyelid issues that you would recommend? Absolutely. You know, one of the most frequent concerns people have is just calling it dark circles.

And when someone says, I have dark circles, it can be a combination of things. It could be one of them. And so we always define the problem and then define the solution.

So under eye bags and dark circles can include issues with pigmentation, with hollowness, and with fat. So let's take a look at what this looks like. So here's somebody who has hollowness in this area, clearly, but also will say, I have dark circles.

because of the pigmentation. So this is an area where we can do something that's very effective, and that is to treat a hollow. So this area right here is called the tear trough.

Now this person also happens to have a little under eye puffiness, but what I did was I placed a little bit of hyaluronic acid in this area to soften the contrast.

And by doing that, you don't see it as a dark circle as much. Now it looks softer and it blends in very nice. So this was done with the hyaluronic acid filler.

It takes a few minutes done in the office and can last six months to a year, sometimes longer. Now it comes to under eye bags. So under eye bags has to be one of the most common problems I see because it does not discriminate.

It does not discriminate by age, ethnicity, gender, everybody. I've seen young children with eye bags, yeah. Patients will tell me that regardless of how old they are, they'll say, I've had bags since I was a child.

This is where if you have bags that are too big, too big to camouflage, then a surgical procedure is indicated. Now, of course, there are different ways to address this.

The way I address it, I do things where I sculpt the fat from the inside of the eyelid. By doing that, I'm thinking about the functional aspect of the lower eyelids, which is to support the tear film, to maintain the shape, because the golden rule is eyelids that look good function well.

So when you see people who've had their eyelids pulled down too much, they have dry eyes. They have all those issues. And we're able to do this in a way so that we preserve the character of their eyes, and we're also able to get them to recover quickly.

So this example, this is a person with classic under-eye bags, which is fat, herniated fat. It's not fluid, it's fat. This is one week later, but virtually no bruising, minimal swelling, and so we're able to get people back to work pretty quickly.

And so more examples, this is a man. People often will stereotypically say to me, are most of your patients women? And I'll say no, it's a resounding no.

Half my patients are men. It has been since day one, 30 years ago. Men also care. about not looking tired. And if they're going to have one thing, anyone, it's going to be to get rid of the bags under their eyes.

And you can see how much brighter the person looks afterwards, this man. And he doesn't look like he had surgery. And so you could have under-eyed bags.

You can do the combination with upper eyelids. And this is, again, in the theme of aging, we see how these changes can also One thing that we should acknowledge is that aging physically does not always correlate with how you feel on the inside.

So I can say that personally that who you are on the inside very often kind of stops somewhere around 30. And so when we're looking at how to improve quality of life, you know, if we make the eyes look a little less tired and they look brighter, we all accept that we're getting older.

We're blessed if we're getting older. But if we can look brighter and more vibrant, it's great. And it's kind of matching the outside closer to how you feel on the inside.

And of course, common question, very much people of all ethnicities, including those with darker skin, very concerned about keloids, about hypertrophin, scars, things like that.

Well, with under eye bags, I really love being able to just relieve them of any worries about keywords because I'm doing this on the inside. And when sculpted so nicely, you see the second picture, no scars and brighter, less tired looking.

Those are some just phenomenal results, Dr. Persaud. You really have such skilled hands. And I think also what I'm hearing from you is there are a multitude of changes that can happen.

You know, it's important to personalize each approach, but also not be too aggressive. You know, you mentioned earlier that too much work can sometimes cause dryness of the eyes or cause, let's say, more expressionless face.

You don't want to cause something that would be unnatural. You want it to be natural and not cause side effects. Is that safe to say, Dr. Prasad? I would say a resounding yes.

And of course, there is different, this is an art, and so there are doctors who have a conservative aesthetic, and there are doctors who have a more exaggerated aesthetic.

And it's very common, and I often, there's our phrase, when the student is ready, the teacher appears. You know, the same thing with patients and doctors.

I think that people find doctors they resonate with. And so when patients say to me, I don't want to look like XYZ celebrity or reality show star, you know, they should not be examples, you know, because the people that really have a natural good look, you can't tell that they have this creature.

So my own personal aesthetic is that everyone has a face, has a character to their appearance, their face. That is recognizable to the people that are closest to them, the people who they interact with at work, at home, in their family.

So really preserving character is the essence of how I approach eyelid surgery and all the other surgeries, facelifts, everything else. It's about looking natural.

And it's been consistently successful in that looking natural also for your eyes also means good function of your eyes. So your vision and the function of the eyes that are also affected by aging are protected.

Well, those are words of gold, Dr. Prasad, and I'm sure that many of our listeners, they do resonate with those words because a lot of people, they want to look fresher, but they don't want to look like a different person.

They don't want to look like, as you said, XYZ celebrity. They want to look like themselves. And I think it's important if you want to pursue any of these cosmetic types of treatments is to find a provider who will listen to you and what your needs are and make it a very individualized approach.

Well, this again has been such an amazing discussion and thank you for sharing those slides. I think it really hits home when you see the images and see the before and after photos, such incredible work.

Well, Dr. Prasad, we just have a few minutes left in our time together. Could you share with us maybe one myth or misconception you often hear from your patients when it comes to eyelid changes or cosmetic procedures around the eyes that you'd like to dispel?

There are a lot, but I would say that one of the things that I want to dispel has to do with kind of more of a global understanding of what eyelid surgery is.

Eyelid surgery is very important because of both the aesthetic and the function. So people often worry that if they have a procedure at a younger age or have it done once, they can never have it done again.

That's not true, okay? We can definitely do it, do what is needed, as is appropriate. You know, what I would say is, when it comes to myth busting, which I do a lot, I often have found myself, throughout my years, being essentially not only the surgeon who does the procedure, but also being their primary care doctor for aesthetics.

So I would say that instead of it just being giving you a laundry list of myths, I'd say you find a doctor who you like, you trust, and who is advocating for your interest.

We live in the golden age of internet hype and devices become hot and marketing is done so aggressively that people are asking for devices and treatments without having clear understanding of what it is they need.

So you need someone to be that person for you. So I'd say that would be the takeaway message about the myth busting. You know, I love that. Find a doctor who will be your advocate, right?

That's someone you can work with and who's not just into the latest device that just got FDA approved that's on the market, but who really understands the nuances of all of these different aspects of cosmetic and functional eye health.

Well, thank you again for your time, Dr. Prasad, and for sharing your incredible insights and your work. If any of our listeners wanted to find out more about you, perhaps follow you.

You have an amazing YouTube channel, by the way, so I highly recommend you subscribe to Dr. Prasad's YouTube channel. If they wanted to become a patient, how could they find you?

So what I'll do is I'll put up a slide of the different channels. So if anybody wants to take a screenshot or a photo, my YouTube channel has been very successful because I just love educating.

And so because I just answer questions, people ask questions and I answer them. YouTube and I do that all in all the other social channels as well. And of course our website prasadcosmeticsurgery.com and you could contact us if you'd like to meet in person.

Well, thank you for sharing that. We will include all of those links in the notes below the interview so you will have access to all of Dr. Prasad's amazing online content.

And thank you all for tuning in and I look forward to seeing you all at the next episode. So thank you. Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

Each day is a new opportunity to make choices that empower your well-being. For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks.com.

Stay connected, stay healthy, and join us next time on Doctor Talks. Real talks from real doctors on the issues that matter to you most.

The Art and Science of Youthful Eyes

Rudrani Banik, MD

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