April 11, 2023
It took a global pandemic for me to start looking at foreheads all day. With all my patients wearing masks, I could not look at anything but eyes and foreheads day in and day out. As I would walk into the exam room I immediately focused on my patients’ eyes and forehead expressions to ascertain if the patient was engaged. I started to notice many patients had foreheads that were pristinely wrinkle free and motionless.
Dry Eye Treatments Make My Patients Look Better
Patients also started asking questions related to how their eyes looked when on Zoom meetings. A male college professor sheepishly asked me what eye cream he should use to keep him looking young. Another patient gushed about loving how her face looked after completing her intense pulsed light (IPL) series for her dry eyes. An OSD radiofrequency (RF) follow-up patient could not wait to tell me that all the women in her book club wanted to know what treatments she had done because her eyelids and the skin around her eyes were so snug.
I could no longer ignore the aesthetics outcomes of my OSD patients. They were very happy that they were seeing more clearly and were no longer thinking about their dry eyes, but they also had a bonus of feeling more confident and younger. It took a pandemic to get me to realize that these wonderful OSD treatments were making my patients feel better in more ways than I possibly realized. The time had come to admit to myself I was in the eye health and beauty business.
This paradigm shift made me focus on embracing treatments that would not only be effective for OSD but would also give my patients an aesthetic boost. Why should they be getting these treatments at a med spa down the street when they can get them at my office? In fact, most of my patients told me they were thrilled to find out I was offering these services because they trust me and already have a relationship with my office.
Pre-Pandemic Aesthetics Preparation
Before the pandemic, I had already taken the plunge to invest in an IPL platform, TempSure RF, low-level laser (light) therapy (LLLT), Blephex, “eye-friendly” cosmetics, make-up, and a branded skin care line. I also started educating myself about the science of skin, and I made a point of going to as many aesthetic conferences that I could fit in my schedule. At first, I was uncomfortable being the only OD in the room but soon found that this group of providers were very comfortable sharing their best practices.
These conferences gave me the confidence that I was on the correct path for the practice’s future. I also realized there was a lot to learn about our energy devices and the impact they have on the ocular surface. It is important as ODs to expand our knowledge when it comes to aesthetics and what all of these instruments can do to help our patients.
Many of us understand how IPL can improve the ocular surface by targeting inflammation and ocular and facial rosacea and by revitalizing meibomian glands and reducing demodex blepharitis. IPL has become a game changer for many practices. Unfortunately, we cannot use it on all skin types (I-VI), and it is not the one hit wonder we would like it to be. We should never use it to treat an active sunburn or tan, and we need to be prudent if a patient is on antibiotics or recently used Accutane. Retinols should be stopped for at least two weeks before a treatment. Also, we need to check if the patient has had injections or fillers put in their face because you should wait up to two weeks before doing IPL or RF treatments.
TempSure RF has helped me serve my patients of color who have OSD. This treatment modality started getting some attention when an oculoplastic surgeon started noticing some reduction in dry eye symptoms when his patients underwent an aesthetic eye treatment. Ophthalmologist Rolando Toyos, MD, put two and two together regarding IPL and dry eye, and an interest in RF was born.
I realized this intriguing new technology could help to improve the structure and function of the upper and lower eyelids and heat up the meibomian glands more comfortably than other devices I had used in the past. It would also give me a nice aesthetic “lift” to the upper eyelids as well as a reduction in ectropion of the lower lid, making my patient’s blink more efficient.
Private Pay Supports a Larger Staff
It is an exciting time to be in this field! With the addition of aesthetics, our office has seen an increase in private pay since none of our treatments are billed to insurance. Our average revenue per patient was $465 before we started incorporating these treatments and is now around $920 per patient. This has allowed us the privilege of having an advanced laser aesthetician on staff full time to conduct consultations and help with treatments.
Every patient’s treatment package is paired with skin care that helps prepare the skin around the eyes and face for the best results for their energy treatments. It is important to know that the pH of the skin of the face is about 4.7-5.75, which is more acidic than the eyelids at 6.5 and the tears at 6.5-7.6. Many of the facial washes, lotions, and potions our patients use daily around their face and eyes can be contributing to their ocular surface issues.
Use of soap with a high pH causes an increase in dehydrative effect, irritability, and alteration of the bacterial flora. For example, one patient was washing his eyes and face with soft soap (pH 10). His ocular surface was a mess! If you are curious (or a nerd like me) you might be surprised what you have in your shower. Johnson’s Baby Shampoo comes in at 5.5 (very acidic for the eyes but great for the skin), Ivory 9.5, Olay 7.0, Dial Gold 5.2-6.2, Aveeno Baby Wash 5.5, and Dove bar soap at 7.0. The branded facial wash we prescribe has a pH of 5.5. We still prescribe lid hygiene that is appropriate for the patient.
The understanding of cosmetics, lotions, soaps, etc. is vital to achieve good clinical results when it comes to treating the ocular surface. We have a “Cosmetic Tips and Tricks” handout that we give all our female patients, and we discuss with our male patients the importance of only using the lid hygiene products we prescribe. There is nothing worse than a patient completing all their IPL and RF treatments and you are seeing progress but they are not feeling better. Think systemic and first rule out what they are putting on their face. You may be very surprised when you start digging deeper.
Some of our patients of color cannot use IPL, so we use RF exclusively. Most of the time people need both IPL and RF to get better structure/function of the lids (skin tightening), gland expression, and reduction in rosacea/inflammation. The aesthetic side of the equation brings joy and confidence and breeds patient compliance and multiple referrals from friends! Embracing aesthetics was the best decision I have made in the past few years. My patients are happy, and their stories bring me joy. My increase in ROI is a wonderful side benefit!
