new m.d.
Now, for Something Completely Different: Cosmetic Treatments

When I was a resident, I didn't particularly care for occuloplastics. I had a fellowship, which I felt partially interfered with my surgical experience, but I did finish the rotation knowing the location of the angular vein, the importance of closing skin procedures with 6-0 vicryl and how to recognize malignancies.

An Appreciation for Skin Lesions

Now that I'm in private practice, I have a newfound interest in "los párpados." I'm convinced this is because among all my patients, including my 20/25 uncorrected pseudophakes, the ECP patients who have been relieved of regularly taking three bottles of eye drops, the scleritis patients diagnosed with arthritic conditions and even the patients who presented with a metallic foreign body, none are more grateful than the patients with a lid ditzle.

The eyelids are so forgiving, and apparently the bathroom mirror so unforgiving, that these patients are thrilled no matter what I do. In fact, sometimes it seems that there is nothing I can't fix with an 11 blade, gentle cautery and Maxitrol ointment. I've grown to love the lowly papilloma. I get to take off my white coat, stop running from room to room and even talk for a bit.

The most natural way I have found to bring such lesions to a patient's attention is to focus in on the eyelids for a moment at the completion of my motility exam. The patient can see that I'm looking at the contour of their eyes, and as I adjust their head into the slit lamp I ask, "does this nodule bother you?" I'm amazed how often patients reply, "no," only
to add that they have wanted the growth removed for years but never knew whom to ask. I'm equally amazed how many patients are surprised ophthalmologists
can remove lid lesions. "Really? You do that?"

Since I've taken a liking to these minor eyelid procedures, I'm in the midst of launching a Botox program for our practice. We will offer some promotional coupons and have posters and flyers distributed in the clinic.

However, I have yet to find the ideal way to inform patients who appear to be good candidates that we are offering this service. To do so seems to draw attention to their wrinkles and age.

On the one hand, I don't want my female patients thinking that the first things that I notice are their crow's feet and bunny lines. Nor do I want to encourage them to wear any more makeup than they already do. On the other hand, there are a lot of patients in our community who are already getting Botox, and many within our practice who would be interested.

"Does that bother you?" seems a rather absurd introduction to ask patients about their wrinkles. Of course, wrinkles bother patients, that's why we pay good money to get them airbrushed out of wedding photos and why Michelangelo's "David" is 16 and not 56. It's because we appreciate the beauty
of youth.

Lately I have settled on, "We're starting to offer Botox and here's a promotional coupon if you or a friend are curious." That way, it doesn't imply that they need Botox, just that they may know somebody else who would be interested.

Had I known I would have been involved in the cosmetic side of ophthalmology, I would have paid more attention during my plastics rotation.

Roxanne Woel, M.D., practices at Koch Eye Associates in Warwick, R.I. Her e-mail is roxannewoel@hotmail.com.