Eyecare professionals can address functional symptoms of ocular disease, as well as periocular aesthetic care and cosmetic concerns, in both separate and combined treatment frameworks, Selena McGee, OD, FAAO, Janelle Davison, OD, and Shalu Pal, OD, said in their “Beauty in Focus: Elevating Eyecare Through Ocular Aesthetics” presentation at Vision Expo. The presenters highlighted specific technologies for addressing meibomian gland dysfunction (MGD), ocular rosacea, and periorbital aging in patients in their late 30s to early 60s.
According to Drs. McGee, Davison, and Pal, optometry and ophthalmology are positioned to address both the medical and aesthetic aspects of these conditions because clinicians routinely evaluate the eyelids, tear film, and periorbital skin.
Intense Pulsed Light (IPL)
IPL reduces inflammation and improves meibum flow through photothermolysis of abnormal blood vessels in ocular and facial rosacea, telangiectasia, redness, and MGD. From the patient case examples the presenters gave, they stressed strict sun protection and the use of Fitzpatrick skin typing to avoid complications. To get patient buy-in, they suggested, set expectations of gradual improvement over 2 to 3 sessions and present before and after photos. Be sure to also discuss risks, which include erythema, blistering, and pigment changes.
Radiofrequency (RF)
RF is indicated for periorbital rhytids, mild dermatochalasis, skin tightening, and dry eye related to MGD. Treatment protocols typically involve a series of 3 to 5 sessions, and RF may be combined with IPL to enhance outcomes.
They described the case of a 39-year-old female patient with fine rhytids, dermatochalasis, and mild dry eye. After determining she was not a candidate for surgical intervention, they proceeded with RF skin tightening and microneedling for collagen remodeling in the under-eye area, as well as adjunctive MGD therapy. “Patients must understand that collagen remodeling takes months,” they said. “We can help them understand that by saying ‘We’re building the scaffolding under your skin.’”
Neurotoxins
Botulinum toxin is a treatment option for dynamic facial rhytids, particularly in the glabella and lateral canthal regions. Results usually begin within 5 to 7 days, peak around 2 weeks, and last approximately 3 to 4 months.
In this corresponding case presentation of a 38-year-old patient who reported “appearing angry on Zoom calls” as well as brow strain headaches, Drs. McGee, Davison, and Pal mentioned a possible functional benefit for neurotoxin as well as an aesthetic one. However, they noted that dynamic rhytids are responsive to neurotoxin, but static rhytids require resurfacing and fillers. Clinicians can show patients the differences in dynamic vs static wrinkles in a mirror. It’s also important to undertreat in the first session and titrate on follow-up, and “always assess symmetry pretreatment to determine the desired results, as well as capture before and after examples,” they said. “Beauty is symmetry. Remind patients that we’re softening movement, not freezing expression, to enhance their beauty.”
Laser Resurfacing
Laser resurfacing is another option for patients with sun damage, static wrinkles, and dermatochalasis. Nonablative treatments typically produce 2 to 3 days of erythema, while ablative procedures may require several weeks of recovery, which is why the nonablative option was right for the 62-year-old patient they described, who did not want to have substantial downtime while looking “less tired.” Sun protection is a must and a non-negotiable. “Pro tip,” they said, “the rules for dynamic versus static rhytid treatment apply here as well.”
Blending Therapies
When a patient presents with a need for blended therapies and comanagement, as in the case of a 55-year-old patient who had ocular rosacea, brow ptosis, and periorbital laxity, Drs. Davison, McGee, and Pal recommended layering therapies to maximize results: IPL for rosacea and MGD, RF for tightening, neurotoxin for glabellar lines, and a tailored daily skincare regimen with sunglasses and sunscreen. Referral for browpexy was also a consideration if the patient wasn’t satisfied with the lift from the other therapies. “Treat inflammation, then build structure, and then refine,” they described. “This sequence matters.”
In all these cases, photos can “showcase the multimodality transformation,” said Drs. McGee, Davison, and Pal. “Every patient brings both function and form. When we treat both, we don’t just improve vision—we elevate lives.”