Q: What is the best way to tell my surgeon that I am not happy afer my surgery 6 mos ago? I have never been happy, but I am at the point where I need things to be corrected. How do I say this without being disrespectful or putting on the defense? He’s just been brushing me off this whole time telling me to patient and that things look pretty good. What am I supposed to be patient for, it has been 6 months. Please help

A: As an Oculofacial (Specialist in Eyelids and Facelifts) Plastic Surgeon in New York City, approximately 10-20% of my practice is revision surgery. If you are dissatisfied about your result, you should articulate specifically what aspects of the surgery you are not happy with and what you expected to change. Many times, miscomunication before and after surgery can lead to bad feelings all around. There are often options which can be minimally invasive to enhance the results of surgery which can lead to a higher level of satisfaction. if you are at a point where you feel your doctor whill not communicate with you, you may want a second opinion. It is important to remeber that a second opinion is not always the right opinion.In a field like cosmetic surgery where results are subjective, it’s best to get specifics about any difference in treatment strategy without casting any personal judgment on the doctor who performed your surgery.

Amiya Prasad, M.D.
Eyelid Surgery Specialist

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“Doctor Prasad [It was much appreciated...] the amazing job that you did to me. Thank you very much. I am very happy.”

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

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

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

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

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

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

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

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

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

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

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

Pelleve Treatment

The Natural Filler – Platelet Rich Plasma

In our practice, we have some people who come in and want a natural filler with no risk of allergic reaction. Recently people have come in asking for the “vampire facelift” or the “Dracula facelift” where the person’s own blood is used to rejuvenate their appearance in a way like popular fillers such as Restylane. This procedure is not a surgical facelift nor does it create the same effect as a facelift. The procedure helps restore or enhance areas which require volume. Platelet rich plasma (PRP) can be used for the following:

• Improve the glabellar lines (the number 11 sign between the brow)
• Improve the Forehead lines
• Improve the appearance of periorbital lines (crow’s feet)
• Improve Nasolabial folds
• Improve smile lines
• Treat acne scars
• Improve the vertical lip lines (lipstick lines)
• Improve the marionette lines (the ones from the corners of the mouth to the chin)

Dr. Prasad has been using the process of platelet rich plasma to enhance and restore the skin of the face and neck. Platelet rich plasma (PRP) contains growth factors which stimulate your body to repair and restore tissues using your body’s own natural processes. With his technique, Dr. Prasad is able to rejuvenate your skin by isolating elements from your blood which can then be injected below wrinkles, folds and even acne scars.

Platelet rich plasma(PRP) systems such as Selphyl® technology, produce a platelet rich fibrin matrix (PRFM) from your own blood. This PRFM contains the growth factors your body uses to initiate and control wound healing. Dr. Prasad uses platelet rich plasma (PRP) to improve wrinkles, folds and scars (including acne scars) on your face in combination with or without surgery or lasers.

In face Dr. Prasad also uses platelet rich plasma (PRP) to accelerate recovery from and to enhance the results of rhinoplasty, facelift, fat transfer and facial implant surgery.

The Process

A small amount of your blood is drawn (like having routine blood tests in your doctor’s office), and Dr. Prasad uses platelet rich plasma (PRP) with Selphyl® technology (an FDA cleared device to separate the elements of your blood in a specific way) to generate a platelet rich fibrin matrix (PRFM). This Selphyl® PRFM primarily contains fibrin, a natural blood protein, and platelets, the part of your blood chiefly responsible for stopping bleeding. Howver, in additionto this function, platelets also contain growth factors, proteins which signal cells in your body to perform tasks such as producing or reorganizing collagen, developing blood vessels, etc. The platelets in the Selphyl® PRFM, as opposed to other platelet systems, release these growth factors in a concentrated but natural way.

It is believed that these growth factors stimulate the cells in the tissue treated, such as those below wrinkles, folds, laugh lines and acne scars, to rejuvenate the skin over the next few weeks.

The Procedure

After determining that platelet rich plasma (PRP) or Selphyl® platelet rich fibrin matrix (PRFM) is right for you, a small amount of your blood will be drawn, similar to having basic blood tests at your doctor’s office. This will then used to prepare the Selphyl® PRFM in a 6 minute process. During that time, the areas of the face to be treated will be cleansed and numbed, either with a topical cream or spray or with a small injection.

Once this is done, the platelet rich plasma (PRP) or Selphyl® PRFM is injected into the skin to be treated. Cool compresses are then applied to these areas. The entire process typically takes no more than 15-20 minutes.

What to Expect Afterwards

Immediately after treatment with platelet rich plasma (PRP) or Selphyl® platelet rich fibrin matrix (PRFM), the treated area is slightly red; this typically fades in a few hours. There is usually very little bruising, which is generally limited to a few “points” and can easily be covered with make-up. There is some mild swelling, which in most patients fades in a few days. Beyond this, there is usually some “settling” of effect over the first 1-2 weeks, after which the improvements noted are long-lasting. Selphyl® PRFM can provide a natural-looking improvement using your body’s own capacity for repair and regeneration.

Click here for a recent article published in the journal “Journal of Drugs in Dermatology” about Platelet Rich Plasma

Before and After Examples

Shown here are before (left) and after (right) views of actual patients. It’s important to remember that every patient responds differently to surgery, and no one can be certain that he or she will get the results shown. However, these photos will illustrate the changes that are possible with these procedures.
Platelet Rich Plasma