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Bimatoprost for ‘chemical’ blepharoplasty?

Topical bimatoprost (Latisse, Allergan) is approved for the treatment of hypotrichosis, but using it off-label might help patients achieve a chemical blepharoplasty, according to a presentation given yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.

Deborah S. Sarnoff, M.D., clinical professor of dermatology at New York University School of Medicine, presented her experience and new study, published May 2015 in the Journal of Drugs and Dermatology, on the use of bimatoprost beyond eyelashes.

In the study, Dr. Sarnoff and plastic surgeon Robert H. Gotkin, M.D., report significant changes in the appearance of the periorbital area after applying topical bimatoprost ophthalmic solution, 0.03% to the upper eyelid margins. The authors write that while published reports in the literature suggest side effects and potential complications from the drug, including prostaglandin-associated periorbitopathy, or PAP, theirs is the first report in the dermatology and plastic surgery literature looking at the rejuvenating effect of topical bimatoprost on the periorbital area. 

“While periorbitopathy implies pathology or a state of disease, we report changes that can be perceived as an improvement in the overall appearance of the periorbital area. We, therefore, propose a name change from PAP to PAPS — prostaglandin — associated periorbital syndrome. This better describes the beneficial, as well as the possible negative effects of topical bimatoprost,” according to the study authors.

Dr. Sarnoff says she treated herself with bimatoprost for eyelash enhancement and used her case report for the study. She applied the topical to the base of the upper eyelid cilia daily for three months; then, reduced application to two to three times a week. By 3 months, her eyelashes were noticeably fuller. Dr. Sarnoff also notes deepening of the upper eyelid sulcus, improvement in the hooding of the upper eyelids, involution of the dermatochalasis in the upper and lower lids, decrease in lower eyelid fat bulging and lower lid skin tightening, according to the study.

"Although there is a risk for periorbital changes that could lead to disfigurement in some patients, in properly selected candidates, when used bilaterally and the dose titrated appropriately, bimatoprost can have a rejuvenating effect beyond eyelash enhancement. It can improve hooding and dermatochalasis of the upper eyelid, diminish lower eyelid fat pads and tighten periorbital skin,” Dr. Sarnoff says. “The striking improvement in the periorbital appearance of some individuals using bimatoprost (Latisse), warrants further research into its potential use to achieve a 'chemical blepharoplasty.'"

Dr. Sarnoff reports no relevant disclosures.

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