|Year : 2017 | Volume
| Issue : 7 | Page : 543-544
Let's face it: The potential of periocular aesthetics
Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, Telangana, India
|Date of Web Publication||20-Jul-2017|
Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Honavar SG. Let's face it: The potential of periocular aesthetics. Indian J Ophthalmol 2017;65:543-4
Ophthalmology is indeed an interesting specialty, encompassing a wide spectrum of clinical conditions. Cataract surgery is traditionally perceived as a must-have skill for an ophthalmologist. It makes up a bulk of income of a comprehensive ophthalmologist. Minor eyelid, conjunctival and lacrimal surgeries, glaucoma, and squint typically add little to the volume. Refractive surgery is investment intense and is potentially rewarding. Aging population and high incidence of diabetes have recently brought medical ophthalmology into the limelight, with sharply increasing numbers of laser procedures and intraocular injectables.
What is often ignored is what is obvious – the eyelids and periocular area. Eyes play an essential role in human interaction, and are one of the most looked-at body parts for both the genders., Eyes are the most sung about too - in a study of 10,000 songs, project Fleshmap found that the most crooned-about human body part was the eye. It is easy to understand why there is a steady growth in the uptake of periocular and eyelid aesthetic procedures worldwide, with India not being an exception. The International Society of Aesthetic Plastic Surgery (ISAPS) recently released the results of their annual Global Aesthetic Survey 2016, which showed a 9% growth in surgical and nonsurgical cosmetic procedures over a year. India ranks seventh with 878,180 aesthetic procedures performed in 2016. Not bad at all for a typical conservative population! Blepharoplasty continues to be one of the world's most popular cosmetic procedures (12.9%, 1,347,509), only slightly lagging behind breast augmentation and liposuction, but combined with brow lift (261,663), it tops the chart. Botulinum toxin injection continues to be the most popular nonsurgical procedure (4,931,577), but the combined strength of fillers (8,548,597) is mind-boggling. The total number of surgical and nonsurgical periocular procedures comes close to the estimated 20 million cataract surgeries a year globally. Obviously, there is an immense potential. However, the sad story is that ophthalmologists and oculoplasty surgeons do only a minority of periocular procedures. The ISAPS data show that plastic surgeons performed 89%, 82%, and 70% of blepharoplasty, botulinum toxin injection, and hyaluronic acid filler injection, respectively. Clearly, ophthalmologists need to reclaim their anatomical domain.
Interestingly, most of these patients would have passed through an ophthalmologist – for change of glasses, refractive surgery, cataract surgery, glaucoma management, retinal lasers, and injectables. But, we would have missed their mild ptosis, lax skin, periocular wrinkles, etc., and proceeded instinctively to examine our immediate point of interest. We would not even have encouraged our patients to digress and talk about their “heavy” eyelids and wrinkles. Our waiting rooms advertise only the premium intraocular lenses, refractive surgery, or the “sneaking thief of sight.” It is not difficult to understand why we have lost out our domain to plastic surgeons, dermatologists, and even cosmetologists. With the ever-increasing competition for cataracts, ophthalmologists can no longer rely completely on traditional streams of revenue. We need to look out of the box and look at periocular aesthetics as a window of opportunity.
Before an ophthalmologist embarks on performing aesthetic procedures, training is most essential. Although nothing can replace a good formal fellowship training program, if one is interested in a short-term basic training, it must be still pursued with a systematic approach. It requires good reading, attending lectures, workshops and live demonstrations, practicing skills in hands-on courses, and above all, finding a mentor. Botulinum toxin injection and periocular fillers are often subjects of promotional training courses offered by the manufacturers. The All India Ophthalmological Society offers several good instruction courses, and so does Oculoplastics Association of India, with sessions dedicated to aesthetic procedures and hands-on courses, in their annual conferences. The American Academy of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery have excellent training programs and intensive hands-on courses at their annual meetings. Several individual oculoplasty surgeons and institutes offer structured courses. Learning to evaluate a patient for a possible aesthetic procedure and judicious patient selection is the next crucial and logical step, which needs investment of time. Aesthetic patients have high expectations and there is minimal room for error. Ambient clinic environment, staff trained to counsel, and seamless patient scheduling experience are the next sequential add-ons. Once the setup is complete, it is then time to gently get the word out that you are seeking patients for aesthetic procedures. Aesthetic practice typically grows slowly, but steadily by word of mouth and patients cyclically returning for enhancements. Most eye hospitals do not offer oculoplasty and aesthetics as a stand-alone specialty. It is time that they should realize the immense potential of this subspecialty to add on to their patient volume and income and enhance their profile.
Blepharoplasty is one of the most common aesthetic procedures and most gratifying as well. It has a systematic approach, is easy to learn and master, and relatively inexpensive in terms of setting up equipment and instruments. If an ophthalmologist is proficient in minor oculoplasty surgeries already, then blepharoplasty may be the next logical addition to the surgical skill set. This issue of Indian Journal of Ophthalmology carries a featured review article on blepharoplasty. We hope that it will kindle some interest in oculoplasty and aesthetic procedures among comprehensive ophthalmologists, and encourage young ophthalmologists to seek to pursue oculoplasty as a subspecialty fellowship training option.
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