Eye Trends

Thanks to a robust pipeline, a flurry of new products along with inspired uses of existing techniques and technology, the eyelid area are having a moment.

New and Developing Treatments. Peregrine Ophthalmic is developing an injectable drug that seeks to reduce unwanted under-eye bag fat, which would improve the overall aesthetic appearance of patients’ treated eyes, says Steve Yoelin, MD, an ophthalmologist in Newport Beach, CA.

DelNova is developing a novel drug that would allow practitioners to reverse adverse events that are caused by neurotoxins including ptotic eyelids, heavy eyebrows, and worsening mylar edema.

STRŌMA MEDICAL is developing a non-invasive laser system for permanent eye-color change, Dr. Yoelin says. Their technology lightens eye color progressively with each treatment.

UPNEEQ (oxymetazoline hydrochloride ophthalmic solution), 0.1% is a prescription eyedrop used to treat acquired blepharoptosis in adults that entered the market in 2020 from RVL Pharmaceuticals, Inc.

“UPNEEQ is instilled as an eye drop and corrects mild to moderate eyelid ptosis,” says Brian Biesman, MD, an oculoplastic surgeon in Nashville. “The duration of effect is 6-8 hours, and the majority of patients in my experience will use it daily to maintain the results, although some use it twice daily.”

Toxin Injections. For lid ptosis, Steven Fagien, MD, an oculoplastic surgeon in Boca Raton, FL, typically uses Jeuveau or Botox. “At least once a day I treat patients who present with lid ptosis. We can treat mild degrees of lid ptosis right above the lashes. The biggest fear of patients when having toxins is getting a drooping lid. We can also treat aperture asymmetries of the eyelids. The orbicularis muscle closes the lid at the lid margin towards the lashes. If you weaken the orbicularis, or the protagonists, the antagonists lift it up. It’s critical to respect the relationship between these two muscles,” he adds.

Fillers. The recent FDA approval for Allergan Aesthetics’ Juvederm Volbella XC for the improvement of infraorbital hollows in adults was widely considered a milestone. “This is the first hyaluronic acid that is now on the label so Allergan can promote it directly to consumers which is a very big deal,” says Dr. Biesman. “Contrary to what many believe, the Infraorbital area is one of the safest areas to inject from a vascular adverse event perspective, especially with respect to vision loss.”

His workhorse product in this area is Restylane-L. He also uses Restylane Lyft, Belotero Balance +, and RHA Redensity.

Bryn Mawr, PA-based facial plastic surgeon Jason Bloom, MD uses a lot of the new RHA Redensity filler for infraorbital hollow/tear trough filler. “I am finding that Redensity is soft, moldable, and doesn’t have a significant amount of swelling,” he says. The company is now looking to pursue this indication from the FDA.

“The most common complications around the eyelid are heavy eyebrows and droopy eyelids, and heavy eyebrows are more common than droopy eyelids. Dermal filler injections, particularly when injected into the glabella, the nasal bridge and the forehead, carry a risk of blindness,” says Dr. Yoelin. “It’s important for practitioners to exercise caution when injecting fillers into the face, and especially when injecting them into these 3 anatomical regions.”

The ideal filler doesn’t hydrate and is easy to dissolve, says Julie Woodward, MD, Division Chief of Oculofacial and Orbital Surgery at Duke University in Durham, NC. “It should also be moldable and but not migrate, doesn’t create a tindle effect, and can be used to address fine lines. There is no perfect filler for every indication,” she says “From the hydration studies that we performed at Duke and published in Dermatologic Surgery the lowest hydrators are NASHA, VYCROSS15, and Thiofix wet milling technology in Revanesse Versa.”

This article was excerpted from “The Eyes Have It” in Practical Dermatology® magazine (practicaldermatology.com). Read the full article for more, including the role of lasers and PRP.

Laser skin resurfacing, PRP. “In these settings, I believe laser skin resurfacing is the gold standard,” says Dr. Biesman. “However, PRP injections can produce meaningful improvement in some patients.” He frequently uses a 27g cannula and slowly injects PRP between the obicularus muscle and overlying skin. Two to three treatments are typically required and he sometimes combines this with laser treatment.

He has been using a new erbium fiber laser, UltraClear from Acclaro Medical.

Mira Kaga, MD, Founder of The Kaga Institute of Medicine and Aesthetics in Marlboro, NJ, says a lot of patients come in requesting fillers, but don’t realize that they don’t have a deficit to fill. “They may complain about the darkness that emanates from vasculature that is very superficial,” she says

For blue veins, Dr. Kaga will use the 1064nm on Cutera’s excel V+ platform. For more fine reticular vessels, she opts for the 532nm on the Dermastat handpiece. “The most important thing is contact cooling so we are protecting the skin from excessive heat which can cause complications. We can decrease the spot size so we can target even tiny vessels,” she says.

“For periorbital veins, we use an intraocular shield which is similar to a contact lens. This allows us to get close to the lash line without harming any of the anatomy in the area,” she says.

Tattooed eyebrows are a common complaint for many of Dr. Kaga’s patients. To address this problem, Dr. Kaga uses the enlighten laser to break down and eliminate any undesirable ink.

Surgery. For patients who seek a longer lasting option to address the signs of aging of the upper face, surgery is still widely considered to be the most reliable choice.

This article was excerpted from “The Eyes Have It” in the October issue of Practical Dermatology® magazine. Read the full articl at practicaldermatology.com