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Aesthetics: More than just blepharoplasty

Article-Aesthetics: More than just blepharoplasty

Dr. WoodwardFor Julie Woodward, M.D., incorporating aesthetics into ophthalmology practice means offering a range of cosmetic procedure options — from surgical to nonsurgical. 

“Aesthetics is much more than blepharoplasty,” says Dr. Woodward, associate professor of ophthalmology and dermatology and chief of oculofacial surgery at Duke University Medical Center, Durham, N.C. “Blepharoplasty can be enhanced with lasers and injectable fillers to reduce under eye hollows and rhytids, as well as neuromodulators to reduce dynamic rhytids.”

That’s not to mention the roles of topical cosmeceuticals, such as antioxidants, retinoids, anti-pigment agents and moisturizers, which can brighten, soften and hydrate skin, says Dr. Woodward, whose practice provides neuromodulator and facial filler injections, ablative laser skin resurfacing, laser blepharoplasty, brow lift, vascular laser, micro focused ultrasound skin lifting and micro needling radio frequency skin tightening.

Jacqueline R Carrasco, M.D., F.A.C.S., an oculoplastic and orbital surgeon and attending surgeon at Wills Eye Hospital, in Philadelphia, and Lankenau Medical Center, Wynnewood, Penn., says her practice is 40% medical; 60% cosmetic oculoplastic surgery. However, she says, many of her medical patients want a cosmetic outcome and ask about cosmetic procedures.

“I perform a large amount of cosmetic eyelid surgeries — blepharoplasty of the upper and lower lids and brow lifts,”Dr. Carrasco Dr. Carrasco says. 

Oculoplastics is clearly much more than surgery, nowadays. 

“When you are performing cosmetic surgeries of the eyelid and/or face, it is natural to segue into injectables,” Dr. Carrasco says. “I perform cosmetic injections with botulinum toxins… and use many fillers for the eyelids and face.”

There are still other options for an oculoplastic practice, according to Dr. Carrasco, including Kybella (deoxycholic acid, Allergan), an injectable to dissolve submental fat, and nonsurgical options, such as Thermage radio frequency tightening, lasers and chemical peels. 

High patient demand for cosmetic procedures that don’t interrupt their lives is among the reasons to branch out from surgical options. 

“Many patients are looking for less downtime and quick fixes,” Dr. Carrasco says. “Injectables are perfect for this but are limited. The fact is that you may not completely rejuvenate an eyelid without surgery, which many patients in an ophthalmology practice may need ultimately.”

NEXT: For the Love of Aesthetics


For the Love of Aesthetics

There are many benefits of doing cosmetic work. One is that it’s just plain fun, according to Dr. Woodward.

But, she says, cosmetics demands a certain culture in the office to cater to such patients.

“One has to enjoy talking with this patient population in order to be successful,” Dr. Woodward says. “Small talk goes with the territory, so understand your talents and limitations in how well you like to get to know your patients.”

Ophthalmologists who do aesthetic procedures because they enjoy doing them will be better off than those who do so primarily to grow their business, she says. In fact, time in the operating room is generally more profitable than time doing these types of aesthetic procedures.

“So the key to success is to truly enjoy doing these procedures,” Dr. Woodward says. 

Making more money can be a benefit of having a cosmetic practice. The trick is that one has to spend money in order to make it. The cost of botulinum toxins, for example, is about $500 for each vial. So, ophthalmologists have to think carefully about how to best schedule patients to avoid waste, according to Dr. Carrasco. 

“If the bottle is open for only one patient, you will not make a profit over the cost of the product,” Dr. Carrasco points out. 

Fillers have expiration dates, but costs are easier to recoup since patients purchase by syringe, according to Dr. Carrasco. 

 NEXT: The Art of Aesthetics


The Art of Aesthetics

Cosmetics is not only mechanical but also artistic and surgeons in this space need artistic skill, according to Dr. Woodward.

In general, cosmetic patients seem to have different demands than medical patients, according to the doctors. 

“Be prepared,” Dr. Woodward says. “Some patients can be high maintenance and occasionally egotistical; however, the vast majority of patients are happy people who want to look their best.”

Dr. Carrasco likens the cosmetic patient population to ophthalmology patients who want premium intraocular lenses or refractive surgery. As a result, the patient experience is important, she says. 

“Having a contact person for the cosmetic patients and scheduling them quickly — with minimal wait — is important. Also, the look of the office should be updated,” Dr. Carrasco says.

Making money in cosmetic procedures is not a given. There’s a lot of competition not only from other specialties in the aesthetic space, but also from estheticians and med spas. Dr. Woodward says talking to those with experience, who have made it in the business, could help ophthalmologists avoid pitfalls. 

Building an aesthetic practice can take several years, she says.

NEXT: Entering the Aesthetic Space


Entering the Aesthetic Space

Entering the aesthetic market is no small endeavor for the ophthalmologist. According to Dr. Woodward, there is a huge commitment of time and money. 

“Training courses are available both through industry and through a variety of [continuing medical education] courses. Courses such as the Cosmetic Surgery Forum at end of November and Vegas Cosmetic Surgery are excellent places to begin,” she says.

There are many considerations before launching a cosmetic practice. Among those: One must consider expense of staff and space. An insurance policy may be needed to cover products. A tracking system for the products may be necessary to prevent theft. And ophthalmologists who plan to hire physician extenders to do procedures, need to consider their training in managing complications and liability, according to Dr. Woodward.

There also are relatively seamless aspects of working cosmetics into ophthalmology practice. For one: Ophthalmologists who sell glasses are set up for retail sales, so introducing skin care products should be easy, according to Dr. Woodward.

Ophthalmologists also have a good foundation for many of today’s most popular cosmetic options. They’re uniquely trained and positioned to understand the anatomy and complications of many of the cosmetic procedures around the eye, according to Dr. Carrasco. 

“Ophthalmologists have been using botulinum toxins for many medical uses around the eye and they can easily transition to use for cosmetic purposes,” Dr. Carrasco says. “Ophthalmologists also have a vast experience of using hyaluronic acid with intraocular surgery. Hyaluronic acid fillers are the most popular types of fillers, as they have a soft, natural feeling and are completely reversible, if needed, with hyaluronidase.”

Periocular injectables can be a good entry point for ophthalmologists who want to get into cosmetic procedures, according to Dr. Woodward.

Still, there are safety considerations, according to Dr. Carrasco. While hyaluronic acid fillers have been used widely off label to fill in the tear trough, it’s a difficult area to fill because eyelid skin is very thin and unforgiving. 

“There are many other places on the face such as nasolabial folds and mesolabial folds that have a higher success rate and are more conducive to starting a filler practice,” Dr. Carrasco says. 


Dr. Woodward has ties to Allergan, EltaMD, Galderma, Merz and SkinCeuticals. Dr. Carrasco has no relevant disclosures.

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