Upneeq from RVL Pharmaceuticals

WHAT IS UPNEEQ?

Connie Brennan: Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%) is a prescription eyedrop that temporarily improves eyelid drooping due to acquired ptosis. It directly activates alpha-adrenergic receptors in the superior tarsal muscle (Müller’s muscle), stimulating contraction and elevation of the upper eyelids. In clinical trials of once-daily use, patients noticed an improvement in as little as 5 minutes, with full results in 2 hours and lasting for about 8 hours.

WHO ARE THE BEST CANDIDATES FOR UPNEEQ?

Ms. Brennan: Injectables such as neurotoxins and neuromodulators are what we often call the “gateway” products that bring patients in for aesthetic procedures. When we are considering a patient’s entire face, we look closely for ptotic or lowered lids and brows. We want to be sure we are not lowering the lids even more with a forehead injection. Especially good Upneeq candidates are those who have more of a lid show which makes the eyes look smaller, “sleepy”, and more closed with age. I ask patients if they want to try it in the office, letting them know that I want to be sure it works for them prior to prescribing the drop. I place the product in one eye and let them see their eyes side by side. I will often take a photo so they can have an idea of what their eyes look like on camera. As the eye widens, it will also appear brighter.

Patients love the lubricating sensation of the drop and can feel their eyes widen. Cosmetically, Upneeq shortens the distance between the fold and the lashes, making the eye look more open and a little more shapely.

Patients with deeper-set eyes and more of a brow hang will have a less dramatic, more moderate result because they don’t have anywhere for that lid tissue to go. The drop has an additional benefit of whitening the sclera. Even those who do not get as much of a lift can still benefit from an overall brightening of the eye—although this is not an FDA-approved indication.

HOW LONG DOES THE DROP LAST PER APPLICATION? ARE THERE ANY ADVERSE EFFECTS?

Ms. Brennan: The effective time will vary from patient to patient. I am a user, and I get 8 to 10 hours per application. If I want longer results after that, I will use a second drop. Although there are no contraindications, the alpha-adrenergic class of drugs can affect blood pressure and may cause angle-closure glaucoma in patients with untreated narrow-angle glaucoma. I, to date, have not had any problems. Clinicians need to be aware of systemic conditions that can cause low-lying lids such as stroke and/or brain aneurysm, Horner syndrome, myasthenia gravis, loss of the ability to move eye muscles, infection, and ocular tumors. I thoroughly screen patients and ensure that if they have any eye issues whatsoever that they visit their ophthalmologist first and that we are collaborating on their care.

WHAT IS YOUR ADVICE TO OTHERS FOR INCORPORATING UPNEEQ INTO PRACTICE?

Ms. Brennan: RVL has created some excellent marketing materials. I would recommend practitioners keep these front and center—display them in the lobby and the exam room. Trial the drop in the office and also use before-and-after photos for patients to see the difference. Make talking about lids part of the consultation and assessment, as we should always be looking for ptosis or brow lowering and add it to the assessment and treatment plan. The price point for the product is inexpensive compared to most of our procedures.

Ms. Brennan is a paid consultant, speaker, and trainer for Allergan, Galderma, and RVL.