Cosmetic procedures have been, and continue to be, on the rise worldwide. Many physicians of variable specialties are integrating these procedures, particularly the non-surgical aesthetic procedures, into their practices.
The most recent statistics published by the American Society of Aesthetic Plastic Surgeons (ASAPS) show that of the 10 million cosmetic procedures performed in 2009, only 15% were surgical and 85% were non-surgical procedures. The most popular non-surgical procedures are botulinum toxins, dermal fillers, laser hair removal and laser skin resurfacing in that order. Women accounted for 92% of the total, but cosmetic procedures for men have increased 8% since 2008. Most cosmetic patients are between the ages of 35 and 50. The popularity of these procedures has lead to increased revenue for many. Americans spent almost $10.5 billion on cosmetic procedures in 2009. $1.8 billion was spent on skin rejuvenation and $500 million was spent on other nonsurgical procedures such as hair removal and laser treatment of leg veins.
The interest amongst patients has risen. In a poll, 51% of Americans approved of cosmetic surgery regardless of income, sex, marital status, and geographic location. That means half of all patients who visit the ophthalmologist are interested in aesthetic treatments. Examples are LASIK patients who have finally gotten rid of their eyewear and would like to rejuvenate the face, reconstructive patients who seek to smooth out their incisions, burn patients who wish to blend in the effected skin, blepharoplasty patients who have visible incisions or who would benefit from a CO2 laser surgical incision and ocular rosacea patients who are refractory to other conservative management options.
The connection between ophthalmology and aesthetics is well established and dates back to the 80’s when Dr. Allen Scott, an ophthalmologist, first used Botox. He injected his patients who suffered from strabismus and blepharospasm. These patients began to notice decreased facial wrinkling which lead to the FDA approval of Botox Cosmetic. Lash growth products also started with a side effect of an ophthalmology drop. As glaucoma patients used prostaglandin analogs to decrease their intraocular pressure, they noticed their lashes getting longer, fuller and darker. This fortunate side effect led to the FDA approval of Latisse. Finally, as ophthalmologists, we are all well trained and versed in laser technology because of its wide application in the anterior segment and retina. It makes sense for ophthalmologists to extend these treatments to other areas of the face and body.
More importantly, we as ophthalmologists play a key role in aesthetics because the eye is the aesthetic center of the face. Much attention is focused on the periocular area and many women and men spend a lot of their time and resources on ways to rejuvenate the eye area. Procedures that can be used for this purpose include botulinum toxins, dermal fillers, lash enhancers, light therapy and lasers for hair removal, resurfacing and surgery. The lasers and lights can address each of the specific ophthalmic patients mentioned above.
Hair removal is the 3rd most popular nonsurgical cosmetic enhancement in the US. There are many different units that can be used for hair removal, including lasers and light therapy. Intense Pulse Light (IPL) can be effective in patients with dark hair but caution must be used in dark-skin patients. Available IPL units include the Lumenis M22, Cutera Prowave, DermaMed and Palomar Starlux. As well, lasers can be used, such as the Nd:YAG laser, which is made by various companies, and diode lasers.
Laser Skin Resurfacing
Laser skin resurfacing is the 4th most popular nonsurgical cosmetic enhancement in the US and has risen 265% since 1997. Different wavelengths can be used to provide treatment of wrinkles and pigment. 1550nm and 1540nm are nonablative laser wavelengths, whereas 2790nm, 2940nm and 10,600nm lasers are ablative and best used on fair skin types. Examples of nonablative lasers are Solta Medical’s Fraxel and Palomar’s Re:Store lasers. Examples of ablative lasers are Cutera’s Pearl and Pearl Fractional, Sciton’s erbium laser and Lumenis’ UltraPulse Active and Deep Fx CO2 laser. The CO2 laser can be used for surgical incisions as well. Each of these lasers can be used both on the face and off, for the treatment of wrinkles, burns and scars. More recently, these laser technologies have been used on the eyelids to tighten and thicken the skin, thereby reducing wrinkles and dark circles.
Intense Pulse Light
IPL is ranked 8th among nonsurgical cosmetic procedures. Unlike lasers, IPL is a spectrum of wavelengths from 500nm to 1200nm and can be used for the treatment of sunspots, vessels, and hair removal. Recently, an interesting ophthalmic application has been popularized with its use in ocular rosacea and dry eye patients. Many refractory patients have responded to this treatment with significant improvement in their symptoms. Lumenis, Cutera, DermaMed and Palomar, among others, make IPL units that have the full capacity to treat the above conditions.
To help incorporate aesthetics into your ophthalmology practice, many resources are available such as courses, individual trainings, local industry representative education and observerships. When shopping for aesthetic technology, look for versatility of a unit, reliability of the equipment and the company, ease of use, patient safety and cost.