July 11, 2025 • 33 mins
In this episode, I talk with Dr. Amiya Prasad about the many changes that occur around our eyes as we age, from wrinkles and ptosis to dark circles and bags. He walks us through both surgical and non-invasive options, explains how to maintain natural aesthetics, and shares why choosing the right practitioner makes all the difference.
Dr. Amiya Prasad is a board-certified ophthalmologist and a leading expert in ocular plastic surgery with over 30 years of experience. With a background in trauma care and a passion for artistry, Dr. Prasad blends function and beauty to help patients reclaim their confidence through rejuvenating eye procedures. He is also a strong advocate for patient education, offering insights through his popular YouTube channel and clinical practice.
Dr. Amiya Prasad
YouTube: http://youtube.com/user/DrPrasad1
Instagram: https://www.instagram.com/amiyaprasadmd
LinkedIn:https://www.linkedin.com/company/prasad-cosmetic-surgery-&-medi-spa/
Website: https://eyelifts.com/
Facebook: https://www.facebook.com/AmiyaPrasadMD
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
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
(00:20):
called the tear through. 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 doingthat you don't see it as a dark
circle as much. Now it looks softer and it
(00:41):
blends in very nice. So this was done with the
hyaluronic acid filler, Takes a few minutes, done in the office
and can last six months to a year, sometimes longer.
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock, here
to help you boost your IQ with powerful insights that connect
your eyes, your brain and your whole body Wellness.
(01:05):
This episode was recorded duringthe Eye Health summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Hello everyone, I'm your host
Doctor Ronnie Bannock and today I'm so excited to introduce
Doctor Amiya Prasad, a renowned expert in oculoplastics.
Dr. Prasad specializes in addressing age-related eye
(01:28):
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 serviceto share knowledge and
information to as many people aspossible.
So this is great. Thank you.
So, and thank you for those kindwords and for the audience, I
(01:50):
just want you all to know that Doctor Prasad and I go back a
very long ways. And just on a personal note,
doctor our, our moms were best friends.
We, we knew each other growing up.
And Doctor 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 Doctor Prasad. So I'm forever grateful to you.
(02:12):
Thank you. Kind 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 the and our specialties and it's, it's
awesome and it's, you know, it'sreally nice to be able to have
this journey the way we've had it so far.
Yes, absolutely. So let's let's just begin by
(02:34):
asking about your journey because you started off as an
ophthalmologist, but then you did additional training
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
(02:54):
lives by helping them with theirvision.
When I was in my, during my residency, I happened to work at
a level 1 trauma center. And that meant that there was a
lot of opportunity to do reconstructor surgery.
And because plastic surgery is such interdisciplinary
specialty, people had trauma that involved their eye,
(03:17):
involved their face. And so there there was a, a
sudden art and creativity that appeal to me.
And I've always been creative and, and artistic.
And so I always love to draw andI love, I loved photography.
And so it really merged very well.
And of course, I, to this day, 30 years, more than 30 years in
(03:40):
practice, the most beautiful part of the face is the eyes.
So it's incredibly inspiring. And so it's, it was very
straightforward. I, I loved, loved oculoplastics.
And so I was lucky enough to gettrained in it.
Well, thank you for sharing thatjourney, Doctor Prasad.
And I have to say you have certainly found your calling.
(04:01):
I've sent many patients to you and they've come back very, very
happy and grateful with the workthat you've done.
So you're, 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
(04:24):
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 sharemy screen and show you a couple
of things that I think will helpanswer this question.
(04:45):
So we all make eye contact like that's where 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 skin care
(05:06):
market is multibillion people think about caring about
appearance with their eyes. The eye makeup market, if 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
(05:27):
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 110th of a second.
Wow. An amazing study published I
believe in 2006 by Alexander Todorov said that we make up our
(05:50):
minds about others after seeing their face for a fraction of a
second. And it just so happens a
fraction of a section, a second or a 10th of a second is the
same time of a blink of an eye. So it really makes it's a very,
very important that our eyes reflect how we feel.
(06:12):
This is a fascinating study which showed where do we look
when we meet people? When we say when we look at
their face, we the the hot spotsare the eyes.
Wow, that was truly eye opening,pun intended.
I never thought of it like that.I mean, I think instinctively we
all look into the eyes with the person we're speaking with, but
(06:33):
we don't realize that the depth of the implications that that
first look has on our impression.
So thank you for sharing that amazing information.
So, Doctor 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,
(06:55):
what are some of the top things you see in your practice as an
Oculoplastics Dr. 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 is connected how how we look.
(07:20):
So the common issues bags under the eyes.
Patients will always say, peoplekeep asking me if I got enough
sleep when their eye, when your eyes are hooded, they may look
tired. When you look at someone's eyes,
there's a inherently there's a beautiful characteristic shape
(07:40):
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. All right.
Then there's a condition that iscommon and under appreciated
called eyeliptosis. And that's when people look
sleepy. And now a lot of times people
(08:01):
are born with it and a lot of times they may have a mild
ptosis, but as they get older, the the drooping of the eyelid
becomes worse. So I'll just show a couple of
examples of what I described. So this is the classic under eye
bags. And no matter how well dressed
(08:23):
you are, bags under the eyes arejust 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'sunderappreciated.
Plastic surgery often times overlooks the presence of eyelid
(08:47):
tosis. And so people can have eyelid
surgery. But you notice in this
individual, there's not a lot ofhooded 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
your hooded upper lids and you have bags under the eyes.
(09:09):
These are all very common age-related changes.
Of course you know, we we understand that lines and
wrinkles are part of life and that's OK.
There's a balance that is individually determined as to
how much their it takes away from their appearance.
Then there's skin textural changes.
(09:30):
So you see these fine lines and wrinkles that are associated
with sun damage and with sun exposure.
And so wrinkles and lines aroundthe eyes are also very, very
common concerns. But that's essentially the
overview of those most common concerns.
Thank you for sharing those images.
(09:51):
I think many of us have either experienced some of those issues
or definitely, as you know, a provider I've, 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
(10:12):
manage these symptoms. Let's dive a little bit into
first, let's talk about those fine lines and wrinkles.
What are some the the range of options people have to address
those specific types of concerns?
Right. So, and, and, and that's the
keyword is range. Every there's a lot of opinions
(10:33):
about different aesthetic 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 andit's dynamic.
(10:55):
So what we do is we look at people and say, all right, let's
start with symbol. OK, what happens as we the lines
form, we're losing collagen. Collagen is a protein, and
although lots of people drink collagen, helping to replace
collagen, the most basic realityis that the digestive enzymes
(11:18):
breakdown the collagen you drinkand you don't necessarily
deposit collagen. Don't want, I know budget
supplements, it's really not. I mean, you have lots of protein
in your diet, but the collagen supplements?
Yeah, I, I know. And yet, you know, people
wanted, we wouldn't want to takeaction.
So I don't fault anyone for trying, but we lose 1% of the
(11:41):
collagen in our skin every year from the age of 20 to 25.
So you can imagine that that canbe significant and it leads to
the loss of the foundation of the skin.
It goes, it collapses and you get some of these lots.
Now again, we don't, we don't aspire to have just flawless
(12:06):
porcelain skin, but the simplestthing to do is to start with
skin care. And so we, we, 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, when we have
(12:27):
fine lines and wrinkles around the eyes, we can do more
aggressive things like this. 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 the skin
looks because I used a fractional CO2 laser.
And so it refreshes the skin andyou get this fresh new baby skin
(12:52):
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 the. Yeah, no, that, that that's
absolutely right. Because again, the eyes have
such an impact. And now you can see the
(13:13):
beautiful blue color of her eyesand the quality of the skin
being so much fresher. And I, I tell you, you know,
again, psychologically, when we look at ourselves and we like
what we see, we feel more confident and that and that
permeates everything in our lives, our relationships, it's,
it's great. And so for people who maybe
(13:35):
don't have downtime or want justto treat fine lines, we actually
have no downtime lasers like this.
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 this
(13:55):
month to the stimulation of, of the skin with the laser.
So now we get get 2 wrinkles that occur because of activity.
We call that dynamic wrinkles. And that has to do with the
activity. And though 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.
(14:17):
So we're, we're all familiar. The number one non surgical
treatment in the world, Botox and Botox is in the category of
of medications that are called neuromodulators and
neuromodulators essentially relax muscles.
The stereo about Botox is you don't have expression.
(14:39):
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. You've all Dysport Zieman that
have been very, very effective. So this is an example of showing
(14:59):
this, this woman is smiling and contracting, but when with the
Botox on board, it's not as emphasized.
You could still smile, you couldstill be expressive, but you're
not deepening the lines. And this example is really good
because this is, she's doing it almost exactly the same
(15:19):
expression in the second picture.
And yet she doesn't cause the breakdown of collagen as we get
older to from the repeated deep creasing.
So again, it's art like everything else we do.
Well, thank you for sharing those images, Doctor Preside.
It's so helpful to visualize what you're talking about
(15:42):
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 multipleoptions 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. Now the next very common
(16:02):
condition that many of my patients come in with are kind
of like eyelid bags and sacks, which I think you should 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, what I want to echo
(16:25):
about what you just said is thatpeople have so many options.
And we live in a time where information is plentiful.
But now there's a difference between information and
knowledge. And so meeting with a
practitioner who is going to help you navigate is critically
(16:48):
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 dermatical asis
and ptosis. So when we look at somebody, and
(17:12):
this is this is actually kind ofa view into how I do my
evaluation, we see drooping Isles dramatical Asis.
So it's excess skin. Now, if I ask myself about
whether or not somebody has justexcess skin, we can evaluate it
further, but that's a start. And so when we have only excess
(17:32):
skin, we can do something calleda upper eyelid blepharoplasty.
And 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 bebeautiful, but when they're
(17:52):
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
(18:15):
drooping eyelids and I see this dramatic Oasis 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 see look at the eyelid height, you can see this
eyelid is kind of low. So not the heavy skin only
(18:36):
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
(19:00):
and this way she has a nice balance, 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, you know,whether it's excess skin or
(19:20):
medical Isis or whether the lid is actually droopy, it also
effects our vision, right? Doctor Purcell?
Like, we're not able to see someof our worlds 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.
No, absolutely. In fact, the feedback I get is
(19:41):
that patients feel like they canjust 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 all constantly raising their
eyebrows. So there's a lot of quality of
(20:02):
life. That's also improved, and not
only the confidence that comes from having nice natural looking
eyes. Wow.
Thank you. Yes, that is so, so true.
Well, Doctor Prasad, this has been such an enlightening
conversation. We are going to take a very
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One of the very common things that I see in my patients is
many of them complain of bags orpuffiness under their eye or
(21:26):
even really, you know, heavily pigmented areas which we know as
dark circles. What are some potential
solutions for those kinds of eyelid issues that you 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
(21:46):
dark circles, it can be a combination of things.
It could be one thing. And so when we 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 this looks like.
(22:11):
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
(22:32):
called the tear through. 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 doingthat you don't see it as a dark
circle as much. Now it looks softer and it
(22:53):
blends in very nice. So this was done with the
hyaluronic acid filler, 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 it it does not
(23:15):
discriminate. It does not discriminate by age,
ethnicity, gender. Everyone.
Everybody gets to have I've. Seen children, I've seen young
children with eye bags. Yeah, yeah.
Patients will tell me that, you know, regardless of how old they
are, they'll say I've had bags since I was a child.
(23:36):
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 I sculpt the fat
from the inside of the eyelid. By doing that, I'm thinking
(23:57):
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 they have dry
eyes, they have all those issues.
(24:19):
And we're able to do this in a way so that we preserve the
character of their eyes and we 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
(24:40):
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 almost
your patients women and I'll sayno, it's a resounding no.
Half my patients are men. It has been since day 130 years
(25:02):
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 eye bags.
You can do the combination with upper eyelids.
(25:24):
And this is again in the theme of aging.
We see how these changes can also, you know, one thing that
we, we should acknowledge is that aging physically does not
always correlate with how you feel on the inside.
So I, I, I can say that personally that you know, who
(25:47):
you are on the inside very oftenkind of stops somewhere around
30. And so when we're, when we're
looking at how to improve quality of life, you know, if we
make the eyes look a little lesstired and they look brighter, we
all accept that we're getting older.
We, we're blessed if we're getting older, but if we can
look brighter and more vibrant, it's, it's great.
(26:10):
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 concernedabout keloids, about
hypertrophic scars, things like that.
Well with under eye bags I really love being able to just
(26:35):
relieve them of any worries of our keylords because I'm doing
this on the inside. And what sculpted so nicely You
see the second picture, No scarsand brighter, less tired
looking. Those are some just phenomenal
results, Doctor First said. You really have such skilled
hands. And I think also what I'm
(26:57):
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, you know, let's say, you
know, more kind of expressionless face.
You don't want to, you don't want to cause something that
(27:18):
would be unnatural. You want it to be natural and
not 'cause side effects. Is that, is that safe to say,
Doctor Prasad? I would.
I would, I would say a resounding yes.
And of course there is differentthis is an art.
And so there are doctors who have a conservative aesthetic
and there are doctors who have amore exaggerated aesthetic and
(27:40):
it's very color. And I often this our phrase,
when the student is is ready, the teacher appears, you know,
the same thing with with patients and doctors.
I think that people find doctorsthey 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, they should not
(28:07):
be examples, you know, because the people that really have a
natural good look, you can't tell that they have this
feature. 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
(28:28):
to them, the people who they interact with at work, at home,
and the family. So, so really preserving
character is, 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
(28:51):
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,
Doctor Prasad. And I'm sure that many of our
listeners, they, they do resonate with those words
(29:13):
because a lot of people, they, they want to look fresher, but
they don't want to look like a different person.
They don't want to look like, asyou 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. And it's been such an amazing
(29:35):
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, Doctor Prasad, we just
have a few minutes left in our, our time together.
Could you share with us maybe 1 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?
(29:58):
There are a lot, but. I, I would say that, you know,
one of the things that I want todispel is has to do with kind of
more of a global understanding of what eyelid surgery is.
Eyelid surgery is very importantbecause of the, both the
aesthetic and the function. So people often worry that if
(30:21):
they have a procedure at a younger age or have it done
once, they can never have it done again.
That's not true. OK, 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, I found myself in throughout my
(30:43):
years being essentially not onlythe 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
(31:07):
for your interest. We live in the golden age of
Internet hype and devices becomehot and marketing is done so
aggressively that people are asking for devices and
treatments without having a clear understanding of what it
(31:32):
is they need. So you need you need someone to
be that person for you. So I'd say that would be the
take away message about the mythbusting.
You know, I love. That find a Doctor Who will be
your advocate right that's that's yeah someone you can work
with and who's not just into thelatest device that just got FDA
approved that's on the market who really understands the
(31:54):
nuances of all of these different aspects of cosmetic
and functional eye health so Well thank you again for your
time doctor 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 subscribe to doctor
(32:14):
Prasad's YouTube channel if or 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, you know, my YouTube channel has
been has been very successful because I just love educating.
And so because I, I just answer questions, people ask questions
(32:38):
and I answer them on YouTube andI 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
would 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 the Doctor
(32:59):
Prasad's amazing online content.And thank you all for tuning in.
And I look forward to seeing youall at the next episode.
So thank you. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
episode and learn something new to help you boost your IQ.
Leave us a review and share the podcast with your family and
(33:21):
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
Until next time, keep your vision clear and your IQ sharp.
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
(00:20):
called the tear through. 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 doingthat you don't see it as a dark
circle as much. Now it looks softer and it
(00:41):
blends in very nice. So this was done with the
hyaluronic acid filler, Takes a few minutes, done in the office
and can last six months to a year, sometimes longer.
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock, here
to help you boost your IQ with powerful insights that connect
your eyes, your brain and your whole body Wellness.
(01:05):
This episode was recorded duringthe Eye Health summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Hello everyone, I'm your host
Doctor Ronnie Bannock and today I'm so excited to introduce
Doctor Amiya Prasad, a renowned expert in oculoplastics.
Dr. Prasad specializes in addressing age-related eye
(01:28):
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 serviceto share knowledge and
information to as many people aspossible.
So this is great. Thank you.
So, and thank you for those kindwords and for the audience, I
(01:50):
just want you all to know that Doctor Prasad and I go back a
very long ways. And just on a personal note,
doctor our, our moms were best friends.
We, we knew each other growing up.
And Doctor 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 Doctor Prasad. So I'm forever grateful to you.
(02:12):
Thank you. Kind 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 the and our specialties and it's, it's
awesome and it's, you know, it'sreally nice to be able to have
this journey the way we've had it so far.
Yes, absolutely. So let's let's just begin by
(02:34):
asking about your journey because you started off as an
ophthalmologist, but then you did additional training
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
(02:54):
lives by helping them with theirvision.
When I was in my, during my residency, I happened to work at
a level 1 trauma center. And that meant that there was a
lot of opportunity to do reconstructor surgery.
And because plastic surgery is such interdisciplinary
specialty, people had trauma that involved their eye,
(03:17):
involved their face. And so there there was a, a
sudden art and creativity that appeal to me.
And I've always been creative and, and artistic.
And so I always love to draw andI love, I loved photography.
And so it really merged very well.
And of course, I, to this day, 30 years, more than 30 years in
(03:40):
practice, the most beautiful part of the face is the eyes.
So it's incredibly inspiring. And so it's, it was very
straightforward. I, I loved, loved oculoplastics.
And so I was lucky enough to gettrained in it.
Well, thank you for sharing thatjourney, Doctor Prasad.
And I have to say you have certainly found your calling.
(04:01):
I've sent many patients to you and they've come back very, very
happy and grateful with the workthat you've done.
So you're, 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
(04:24):
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 sharemy screen and show you a couple
of things that I think will helpanswer this question.
(04:45):
So we all make eye contact like that's where 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 skin care
(05:06):
market is multibillion people think about caring about
appearance with their eyes. The eye makeup market, if 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
(05:27):
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 110th of a second.
Wow. An amazing study published I
believe in 2006 by Alexander Todorov said that we make up our
(05:50):
minds about others after seeing their face for a fraction of a
second. And it just so happens a
fraction of a section, a second or a 10th of a second is the
same time of a blink of an eye. So it really makes it's a very,
very important that our eyes reflect how we feel.
(06:12):
This is a fascinating study which showed where do we look
when we meet people? When we say when we look at
their face, we the the hot spotsare the eyes.
Wow, that was truly eye opening,pun intended.
I never thought of it like that.I mean, I think instinctively we
all look into the eyes with the person we're speaking with, but
(06:33):
we don't realize that the depth of the implications that that
first look has on our impression.
So thank you for sharing that amazing information.
So, Doctor 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,
(06:55):
what are some of the top things you see in your practice as an
Oculoplastics Dr. 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 is connected how how we look.
(07:20):
So the common issues bags under the eyes.
Patients will always say, peoplekeep asking me if I got enough
sleep when their eye, when your eyes are hooded, they may look
tired. When you look at someone's eyes,
there's a inherently there's a beautiful characteristic shape
(07:40):
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. All right.
Then there's a condition that iscommon and under appreciated
called eyeliptosis. And that's when people look
sleepy. And now a lot of times people
(08:01):
are born with it and a lot of times they may have a mild
ptosis, but as they get older, the the drooping of the eyelid
becomes worse. So I'll just show a couple of
examples of what I described. So this is the classic under eye
bags. And no matter how well dressed
(08:23):
you are, bags under the eyes arejust 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'sunderappreciated.
Plastic surgery often times overlooks the presence of eyelid
(08:47):
tosis. And so people can have eyelid
surgery. But you notice in this
individual, there's not a lot ofhooded 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
your hooded upper lids and you have bags under the eyes.
(09:09):
These are all very common age-related changes.
Of course you know, we we understand that lines and
wrinkles are part of life and that's OK.
There's a balance that is individually determined as to
how much their it takes away from their appearance.
Then there's skin textural changes.
(09:30):
So you see these fine lines and wrinkles that are associated
with sun damage and with sun exposure.
And so wrinkles and lines aroundthe eyes are also very, very
common concerns. But that's essentially the
overview of those most common concerns.
Thank you for sharing those images.
(09:51):
I think many of us have either experienced some of those issues
or definitely, as you know, a provider I've, 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
(10:12):
manage these symptoms. Let's dive a little bit into
first, let's talk about those fine lines and wrinkles.
What are some the the range of options people have to address
those specific types of concerns?
Right. So, and, and, and that's the
keyword is range. Every there's a lot of opinions
(10:33):
about different aesthetic 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 andit's dynamic.
(10:55):
So what we do is we look at people and say, all right, let's
start with symbol. OK, what happens as we the lines
form, we're losing collagen. Collagen is a protein, and
although lots of people drink collagen, helping to replace
collagen, the most basic realityis that the digestive enzymes
(11:18):
breakdown the collagen you drinkand you don't necessarily
deposit collagen. Don't want, I know budget
supplements, it's really not. I mean, you have lots of protein
in your diet, but the collagen supplements?
Yeah, I, I know. And yet, you know, people
wanted, we wouldn't want to takeaction.
So I don't fault anyone for trying, but we lose 1% of the
(11:41):
collagen in our skin every year from the age of 20 to 25.
So you can imagine that that canbe significant and it leads to
the loss of the foundation of the skin.
It goes, it collapses and you get some of these lots.
Now again, we don't, we don't aspire to have just flawless
(12:06):
porcelain skin, but the simplestthing to do is to start with
skin care. And so we, we, 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, when we have
(12:27):
fine lines and wrinkles around the eyes, we can do more
aggressive things like this. 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 the skin
looks because I used a fractional CO2 laser.
And so it refreshes the skin andyou get this fresh new baby skin
(12:52):
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 the. Yeah, no, that, that that's
absolutely right. Because again, the eyes have
such an impact. And now you can see the
(13:13):
beautiful blue color of her eyesand the quality of the skin
being so much fresher. And I, I tell you, you know,
again, psychologically, when we look at ourselves and we like
what we see, we feel more confident and that and that
permeates everything in our lives, our relationships, it's,
it's great. And so for people who maybe
(13:35):
don't have downtime or want justto treat fine lines, we actually
have no downtime lasers like this.
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 this
(13:55):
month to the stimulation of, of the skin with the laser.
So now we get get 2 wrinkles that occur because of activity.
We call that dynamic wrinkles. And that has to do with the
activity. And though 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.
(14:17):
So we're, we're all familiar. The number one non surgical
treatment in the world, Botox and Botox is in the category of
of medications that are called neuromodulators and
neuromodulators essentially relax muscles.
The stereo about Botox is you don't have expression.
(14:39):
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. You've all Dysport Zieman that
have been very, very effective. So this is an example of showing
(14:59):
this, this woman is smiling and contracting, but when with the
Botox on board, it's not as emphasized.
You could still smile, you couldstill be expressive, but you're
not deepening the lines. And this example is really good
because this is, she's doing it almost exactly the same
(15:19):
expression in the second picture.
And yet she doesn't cause the breakdown of collagen as we get
older to from the repeated deep creasing.
So again, it's art like everything else we do.
Well, thank you for sharing those images, Doctor Preside.
It's so helpful to visualize what you're talking about
(15:42):
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 multipleoptions 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. Now the next very common
(16:02):
condition that many of my patients come in with are kind
of like eyelid bags and sacks, which I think you should 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, what I want to echo
(16:25):
about what you just said is thatpeople have so many options.
And we live in a time where information is plentiful.
But now there's a difference between information and
knowledge. And so meeting with a
practitioner who is going to help you navigate is critically
(16:48):
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 dermatical asis
and ptosis. So when we look at somebody, and
(17:12):
this is this is actually kind ofa view into how I do my
evaluation, we see drooping Isles dramatical Asis.
So it's excess skin. Now, if I ask myself about
whether or not somebody has justexcess skin, we can evaluate it
further, but that's a start. And so when we have only excess
(17:32):
skin, we can do something calleda upper eyelid blepharoplasty.
And 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 bebeautiful, but when they're
(17:52):
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
(18:15):
drooping eyelids and I see this dramatic Oasis 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 see look at the eyelid height, you can see this
eyelid is kind of low. So not the heavy skin only
(18:36):
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
(19:00):
and this way she has a nice balance, 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, you know,whether it's excess skin or
(19:20):
medical Isis or whether the lid is actually droopy, it also
effects our vision, right? Doctor Purcell?
Like, we're not able to see someof our worlds 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.
No, absolutely. In fact, the feedback I get is
(19:41):
that patients feel like they canjust 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 all constantly raising their
eyebrows. So there's a lot of quality of
(20:02):
life. That's also improved, and not
only the confidence that comes from having nice natural looking
eyes. Wow.
Thank you. Yes, that is so, so true.
Well, Doctor Prasad, 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
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One of the very common things that I see in my patients is
many of them complain of bags orpuffiness under their eye or
(21:26):
even really, you know, heavily pigmented areas which we know as
dark circles. What are some potential
solutions for those kinds of eyelid issues that you 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
(21:46):
dark circles, it can be a combination of things.
It could be one thing. And so when we 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 this looks like.
(22:11):
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
(22:32):
called the tear through. 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 doingthat you don't see it as a dark
circle as much. Now it looks softer and it
(22:53):
blends in very nice. So this was done with the
hyaluronic acid filler, 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 it it does not
(23:15):
discriminate. It does not discriminate by age,
ethnicity, gender. Everyone.
Everybody gets to have I've. Seen children, I've seen young
children with eye bags. Yeah, yeah.
Patients will tell me that, you know, regardless of how old they
are, they'll say I've had bags since I was a child.
(23:36):
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 I sculpt the fat
from the inside of the eyelid. By doing that, I'm thinking
(23:57):
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 they have dry
eyes, they have all those issues.
(24:19):
And we're able to do this in a way so that we preserve the
character of their eyes and we 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
(24:40):
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 almost
your patients women and I'll sayno, it's a resounding no.
Half my patients are men. It has been since day 130 years
(25:02):
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 eye bags.
You can do the combination with upper eyelids.
(25:24):
And this is again in the theme of aging.
We see how these changes can also, you know, one thing that
we, we should acknowledge is that aging physically does not
always correlate with how you feel on the inside.
So I, I, I can say that personally that you know, who
(25:47):
you are on the inside very oftenkind of stops somewhere around
30. And so when we're, when we're
looking at how to improve quality of life, you know, if we
make the eyes look a little lesstired and they look brighter, we
all accept that we're getting older.
We, we're blessed if we're getting older, but if we can
look brighter and more vibrant, it's, it's great.
(26:10):
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 concernedabout keloids, about
hypertrophic scars, things like that.
Well with under eye bags I really love being able to just
(26:35):
relieve them of any worries of our keylords because I'm doing
this on the inside. And what sculpted so nicely You
see the second picture, No scarsand brighter, less tired
looking. Those are some just phenomenal
results, Doctor First said. You really have such skilled
hands. And I think also what I'm
(26:57):
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, you know, let's say, you
know, more kind of expressionless face.
You don't want to, you don't want to cause something that
(27:18):
would be unnatural. You want it to be natural and
not 'cause side effects. Is that, is that safe to say,
Doctor Prasad? I would.
I would, I would say a resounding yes.
And of course there is differentthis is an art.
And so there are doctors who have a conservative aesthetic
and there are doctors who have amore exaggerated aesthetic and
(27:40):
it's very color. And I often this our phrase,
when the student is is ready, the teacher appears, you know,
the same thing with with patients and doctors.
I think that people find doctorsthey 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, they should not
(28:07):
be examples, you know, because the people that really have a
natural good look, you can't tell that they have this
feature. 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
(28:28):
to them, the people who they interact with at work, at home,
and the family. So, so really preserving
character is, 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
(28:51):
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,
Doctor Prasad. And I'm sure that many of our
listeners, they, they do resonate with those words
(29:13):
because a lot of people, they, they want to look fresher, but
they don't want to look like a different person.
They don't want to look like, asyou 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. And it's been such an amazing
(29:35):
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, Doctor Prasad, we just
have a few minutes left in our, our time together.
Could you share with us maybe 1 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?
(29:58):
There are a lot, but. I, I would say that, you know,
one of the things that I want todispel is has to do with kind of
more of a global understanding of what eyelid surgery is.
Eyelid surgery is very importantbecause of the, both the
aesthetic and the function. So people often worry that if
(30:21):
they have a procedure at a younger age or have it done
once, they can never have it done again.
That's not true. OK, 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, I found myself in throughout my
(30:43):
years being essentially not onlythe 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
(31:07):
for your interest. We live in the golden age of
Internet hype and devices becomehot and marketing is done so
aggressively that people are asking for devices and
treatments without having a clear understanding of what it
(31:32):
is they need. So you need you need someone to
be that person for you. So I'd say that would be the
take away message about the mythbusting.
You know, I love. That find a Doctor Who will be
your advocate right that's that's yeah someone you can work
with and who's not just into thelatest device that just got FDA
approved that's on the market who really understands the
(31:54):
nuances of all of these different aspects of cosmetic
and functional eye health so Well thank you again for your
time doctor 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 subscribe to doctor
(32:14):
Prasad's YouTube channel if or 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, you know, my YouTube channel has
been has been very successful because I just love educating.
And so because I, I just answer questions, people ask questions
(32:38):
and I answer them on YouTube andI 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
would 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 the Doctor
(32:59):
Prasad's amazing online content.And thank you all for tuning in.
And I look forward to seeing youall at the next episode.
So thank you. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
episode and learn something new to help you boost your IQ.
Leave us a review and share the podcast with your family and
(33:21):
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
Until next time, keep your vision clear and your IQ sharp.
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