We’ve all been asked the questions:
- “What can I do about the bags under my eyes?”
- “What do you recommend for the wrinkles around my eyes?”
- “Is there anything I can do about these droopy eyelids?”
As optometrists, we make it a priority to focus on our patients' visual and ocular health but we may fail to address some of the things that are most concerning to our patients.
Aesthetics is part of what we do every day. The shape and color of the frame a patient chooses is an aesthetic choice. When a patient chooses to wear contacts over glasses, that is most often an aesthetic choice.
Facial aesthetics and optometry have a natural synergy. After all, the face is the canvas on which the eyes are etched.
Focus on the facial aesthetics industry
Globally, the medical aesthetics industry is booming! The market is expected to grow from $25.48 billion in 2024 to $67.89 billion by 2032.1 This ample growth is largely due to the growing popularity of minimally invasive procedures, which are often less painful, carry a lower risk of side effects, require less downtime for recovery, and provide faster results.
The growing popularity of cosmetic treatments in the male population is also fueling the industry’s demand. In addition, these non-surgical procedures are repeatable (and maybe slightly addictive), so patients often return and are willing to pay the price after appreciating the results. The skin resurfacing and tightening segment of the aesthetics market captured the largest market share in 2023.1
Treatments designed to minimize the appearance of fine lines and wrinkles, acne scars, and sagging skin have increased in popularity due to the quick and simple appointments, minimal recovery time, and gradual natural-looking results. This is where optometrists can, and should, implement their expertise as the eyes are the first area to show signs of aging.2
In-office treatments optometrists can utilize for ocular aesthetics
Many devices recently proven to help manage ocular surface disease, specifically related to evaporative dry eye, are devices originally used in the dermatologic and aesthetic space. If you already have these tools in your practice, you should be using them to their full potential.
Be sure you are in compliance with your state’s rules and regulations in regards to these procedures and that your malpractice insurance covers and potential risks associated with aesthetic services.3
Intense pulsed light (IPL)
The approval of IPL for the treatment of dry eye disease secondary to meibomian gland dysfunction (MGD) was a catalyst for optometrists to offer facial aesthetic services. IPL utilizes polychromatic and noncoherent light with a wavelength ranging from 515nm to 1,200nm.4
Light energy is selectively absorbed by a chromophore, such as melanin and hemoglobin, and converted to heat, causing destruction through thermocoagulation of the target tissue without damaging surrounding structures.4,5
Simply, IPL neutralizes the color of the skin. IPL can be used to treat telangiectasias, rosacea, hyperpigmentation, liver spots, freckles, acne vulgaris, port wine stains, hemangiomas, venous malformations, and even to remove unwanted hair.5
There are limitations, however, to who can be treated with IPL. Patients with a Fitzpatrick skin type higher than four cannot receive IPL treatments due to the risk of thermal burns and damage to the surrounding tissue.4
Discussing IPL with patients
When prescribing IPL for a patient with MGD, it is often an easy conversion to a full-face facial aesthetic treatment. If the patient has apparent rosacea or age spots, gently mention to them that the recommended treatment for their ocular discomfort also has the capacity to remove these unwanted features and improve their complexion.
It costs nothing but your time as the practitioner (and a little more ultrasound gel) to add a full-face treatment to a dry eye IPL treatment. However, you should add a respectable amount to the cost of the treatment to the patient…not enough to discourage them from moving forward with the full-face treatment but instead makes them think, “it’s not much more to do the full face.”
The benefit of IPL is cumulative, requiring three to six treatments every 2 to 4 weeks to achieve the full clinical effect.5 In addition, telangiectasias and pigmented lesions will likely return, in which case, patients return for repeated treatments.
Radiofrequency (RF)
Radiofrequency generates heat when resistance converts the electrical current directed at the tissue into thermal energy.6 RF energy generates contraction of the skin both by cleavage of collagen halogen bonds, causing shortening and thickening of the collagen fibrils, and by initiating the wound healing cascade.
This triggers the development of new collagen and elastin fibers through neocollagenesis and elastin reorganization over the following 3 to 4 months.6 The first monopolar RF device introduced in 2001 was initially approved for the treatment of periorbital fine lines and wrinkles before it later gained approval for full face contouring and body contouring.6
Fractional radiofrequency devices use either needles or electrodes to deliver thermal injury to the subdermis.6 These modes of RF allow for enhanced facial resurfacing and improvement in skin texture with expedited recovery time.
The benefits of RF for MGD
In dermatology, radiofrequency is a standard treatment for skin tightening, improving skin laxity, and overall skin rejuvenation,7 notably improving the appearance of lateral canthal and forehead wrinkles, lifting the eyebrow, nasolabial folds, marionette lines, enhancing the jawline, and firming skin on the neck.6
In addition, when targeted around the eyes, the heat generated in RF is helpful in liquefying waxy secretions, aiding in unclogging the meibomian glands.7 RF is safe to use on all Fitzpatrick skin types, and while it does not target the inflammatory component of MGD like IPL does, RF alone is still beneficial in these suffering patients.
For those patients where RF can be combined with the benefits of IPL in the treatment of evaporative dry eye caused by MGD, a synergistic treatment effect is achieved.7 As a result, RF is a natural addition to any optometric practice treating dry eye patients and when presented with the benefit of skin tightening and wrinkle reduction, patients are often pleased to upgrade to an aesthetic treatment involving more of the face and even the neck.
Growing your aesthetic practice: LLLT and muscle stimulation
Once patients start trusting in your practice for their facial aesthetic needs, it is time to start adding additional treatment options. Low level light therapy (LLLT) is an affordable next step.
LLLT delivers various wavelengths of light, primarily red, near infrared, blue and sometimes yellow, to alleviate inflammation and promote wound healing and tissue regeneration. Treatments last between 15 and 30 minutes and are noninvasive and pain free.8
While not currently approved for the treatment of specific ocular conditions, LLLT has been shown to be effective in treating dry eye associated with MGD and ocular rosacea as well as blepharitis, chalazia, and hordeola.8
Newest to the market are devices that use muscle stimulation to restore the muscle tone of the eyelids. Weakening of the orbicularis oculi muscle is a natural process of aging, potentially resulting in impaired lid closure and incomplete blinking. The device activates the facial muscles with an electrical impulse, which promotes tightening and toning of the periorbital muscles and improves lid laxity.9
Advanced facial aesthetic treatments
In most states, expanding facial aesthetic treatments beyond the ocular adnexa to more advanced or invasive procedures will require the supervision of a medical director, typically an MD.3 The medical director’s oversight allows the opportunity to offer laser resurfacing, chemical peels, fillers, and neurotoxins.
In addition, physician assistants, nurse practitioners, and/or aestheticians can all be valuable members of the aesthetic team, performing treatments beyond an optometrist’s scope of practice and offering their expertise.3
How ODs can incorporate facial aesthetics
Incorporating facial aesthetics into an optometry practice may seem daunting (and expensive) at first. The key is to start simple, offering products that make sense in the optometry space. Whitening eye drops, eyelash growth serums, under eye creams, and eye makeup removers are an easy and expected first step.
All products offered in the practice should contain ingredients safe to use around the ocular tissue. After all, your patients trust you to prioritize their ocular health.
Active ingredients to look for include:10,11,12
- Retinoids
- Antioxidants (vitamins C, E, and B3)
- Peptides
- Alpha hydroxy acids
- Hyaluronic acid
- Ceramides
- Caffeine
- Hydroquinone
- Cannabidiol (CBD)
Conversely, ingredients to avoid for periocular use include:10,11,12
- Parabens
- Benzalkonium chloride
- Phenoxyethanol
- Alcohol
- Sulfates
- Isothiazolinones
- Prostaglandin analogs (isopropyl cloprostenate)
- Mineral oil
- Fragrances
To best understand why you should recommend one mass-market product over another, use the products yourself and have your staff members try the products as well. You should be a trusted and informed source for patients as they navigate which products are safe and effective and which products or enhancements, like lash extensions, should be avoided.
To learn more about recommendations optometrists can make for cosmetics, check out Cosmetics and Dry Eye Mythbusting!
Don’t forget sunscreen
It is also essential to recommend and offer good-quality sunscreen in your practice if you are going to enter the facial aesthetic space. Eyelid skin is uniquely thin, putting it at a high risk for photodamage.7 The periocular region makes up only 1% of the body’s surface area yet it accounts for between 5 to 10% of all skin cancers.13
Be sure to check both the active and inactive ingredients in sunscreen products you sell in-office, as many of the preservatives and ingredients mentioned previously are also present in sunscreen. These harmful elements are more prevalent in chemical sunscreen products, which is why many dermatologists favor mineral sunscreen options.13
Conducting a successful facial aesthetics consult
The most challenging part of introducing facial aesthetics into your practice is converting patients from a regular eye exam or ocular health evaluation to an aesthetic consult. Patients do not come into your practice expecting an aesthetic consultation or to pay the price of expensive treatments.
You, as the doctor, must be asking the right questions that get them thinking about facial aesthetics even if that was not their intention when they walked in the door. A short form with the intake paperwork is a simple tool to announce your new aesthetic offerings and allow patients to check off their areas of concern. This will prompt a discussion in the exam room.
First and foremost, address the patient's visual and ocular concerns. Once you have gone over your glasses recommendations and any ocular treatments needed, then discuss the aesthetic concerns they pointed out.
Don’t be shy about bringing up hooded eyelids or skin texture or discoloration…any area you may be able to help them with! Patients are rarely offended and are happy to know the treatment options they can receive from their trusted provider.
Finally, provide the patient a detailed treatment plan addressing their concerns and hand them off to your designated staff member to go over package options and payment, as you would normally when they leave the exam room to pick out glasses.
Billing and insurance considerations for aesthetic procedures
All treatments mentioned here are considered purely aesthetic by insurance companies and, therefore, typically, not covered. On the one hand, this presents a challenge as it leaves the entire payment burden on the patient. On the other hand, it eliminates the hassles of billing and denials.
As more research is conducted and studies prove the medical benefits of in-office facial aesthetic treatments, this could likely change. However, currently, IPL, RF, LLLT, and muscle stimulation are not covered treatments for dry eye disease, despite the proven benefits, and are fully out-of-pocket.
The cost of treatments will vary considerably depending on your location and patient demographics. When starting out, it may be beneficial to price services slightly below those of more established competitors in order to attract patients.
Final thoughts
While building a facial aesthetics practice can take time to develop, it is very lucrative once established. Treatments are not inexpensive, but the potential value added to the patient's quality of life, either through dry eye relief or aesthetics, is invaluable.
Besides the initial equipment cost and subsequent chair time, the procedures discussed here have very low overhead costs, creating an excellent profit margin for your business. However, what is most rewarding is the patient’s satisfaction once completed…and that often brings them back for more.
