Latisse as an Entry Into Aesthetic Treatments

This inexpensive eyelash extender can broaden your patient base.

BY STEVEN YOELIN, MD

I am a board-certified ophthalmologist and during the past eight years I've developed an extremely active adjunct aesthetics-related practice offering neurotoxins, as well as a variety of dermal fillers/collagen stimulators, to patients who feel better about their self-image after having these elective procedures.

Though I was trained to function solely as an ophthalmologist, I�ve found it to be extremely desirable, rewarding and profitable to meet the needs of patients who choose to improve their appearance and self-confidence with the aid of these recently available neurotoxins and fillers. I have seen firsthand the results of these treatments and the increase in self-esteem for these individuals can truly be astounding.

For me, developing a growing practice has been a blessing, particularly in view of the some of the "scary" changes that all practicing physicians have been facing during the past several decades and knowing that we, as physicians, will surely be facing even more jarring changes in the future. I derive some comfort from the fact that my adjunct aesthetics practice is solidly booked throughout 2009, and also well into 2010 and 2011.

In this article, I will discuss the benefits offered by the latest addition to my aesthetics practice, Latisse (bimatoprost ophthalmic solution) 0.03%, a prescription eyelash growth treatment from Allergan. I will also provide a few helpful ideas for ophthalmologists who are interested in using Latisse as a low-risk entry into delivering aesthetic services. This is an avenue that more ophthalmologists should explore, as our training, credentials and credibility will ensure a high level of trust from the patients who seek these services.

Aesthetics Continues to Evolve

Virtually all ophthalmologists are aware of the fact that Botox was initially launched on the ophthalmic market by Allergan as a drug to treat strabismus and blephrospasm. The elimination of wrinkles was first noted in patients being treated for blephrospasm in the form of a "side effect." Sensing an opportunity to qualify an additional indication, Allergan then developed the same product as Botox Cosmetic, which is now FDA-approved to treat glabellar lines and wrinkles. Botox Cosmetic has become hugely popular and is a staple of my own aesthetics practice.

Allergan has been able to capitalize on the new indication for Botox in numerous ways. For example, the company has used the overwhelming success of Botox Cosmetic in order to launch the successful Juvederm hyaluronic dermal filler line of products. More recently, in another serendipitous turn of events, Allergan has been able to find an aesthetic indication for its glaucoma medication Lumigan (bimatoprost).

A Question Leads to a Study

As ophthalmologists, we are familiar with the fact that prostaglandin analogs can grow eyelashes when they are used in the form of topical drops for the treatment of glaucoma. Armed with this knowledge and being keenly interested in the area of aesthetics, I had often asked myself the following question:

"What would happen if a prostaglandin analog like bimatoprost was applied directly to the eyelid margin of healthy volunteers, with the hope of simply growing longer, thicker and more attractive eyelashes?"

Based upon the foregoing question and other related concepts that I felt could be realized, in the fall of 2005 I was in a position to launch an Allergan-sponsored, investigatorinitiated, single-site, open-label, proof-of-concept trial in order to determine what would happen if bimatoprost was applied directly to the eyelash margins of healthy patients.

During the course of the investigation, it quickly became evident to me that every one of the trial subjects grew longer, darker and thicker eyelashes without experiencing any significant ophthalmic side effects.

Moreover, intraocular pressure did not change in a clinically significant manner during the course of the trial and no iris color-related changes were noticed during that time. In addition, no adverse and/or negative results were noticed during the period of years that followed the trial in any of the patients who continued to use the drug.

This initial trial led to a much larger phase 3, multicenter, prospective, double-masked and controlled study to determine the safety and efficacy of applying bimatoprost to the upper eyelid margins of healthy patients. This second trial was instituted by Allergan in order to confirm the results of my initial investigator-initiated trial.

The phase 3 study proved that bimatoprost was safe and effective in growing longer, darker and thicker eyelashes in healthy subjects. Thus, the FDA granted Allergan a new indication for bimatoprost in December 2008. The new product was named Latisse. It is the exact same molecule as Lumigan, but that same product bears a different name due to the fact that it relates to a new indication: eyelash hypotrichosis, another name for having inadequate or not enough eyelashes.

There Are Caveats

Despite its excellent safety profile, Latisse is not suitable for everyone who wants to use it. There should be an initial exam to determine whether a patient is an appropriate candidate for this treatment. Individuals on IOP-lowering medications or patients at risk for eye disorders who would like to use bimatoprost for this indication must consult an eye doctor before starting therapy and must then be closely monitored. In addition, a small number of users have reported itching and/or eye redness. Those patients who are approved for treatment must be shown how to use the product and informed of any potential side effects. (Further prescribing information is available at www.latisse.com).

Patient 1 at baseline before start of Latisse treatments.

Patient 1 at week 16 of daily Latisse treatments.

The exact mechanism of action for Latisse is not known, but it has been postulated that Latisse activates more eyelashes into an anagen (or growth) phase at any given time and that the anagen phase becomes longer when eyelash follicles are exposed to Latisse.

Based upon my own treatment-related experience regarding Latisse, I have added it to my aesthetics practice in the much same way that I added Botox, other neurotoxins and a variety of fillers/collagen stimulators. All such medications can contribute to the building of a successful adjunct aestheticsrelated injectables practice that can be conducted totally "on the side" of a general ophthalmic practice.

Latisse in Practice

In my aesthetics-related practice, Latisse generates income entirely on its own, but what is far more important to me relates to the fact that new patients who begin with relatively inexpensive Latisse treatments are also introduced to my non-Latisse products and procedures.

The suggested retail price for Latisse is $120. The majority of states allow physicians to dispense medications like Latisse directly from their offices. If you work in a state that allows this practice, I urge you to dispense Latisse, because doing so will allow you to create an additional and extremely profitable revenue stream and also enable your patients to better familiarize themselves with your overall practice.

Even if you work in a state that does not allow you to dispense medications from your office, I believe that it will serve you well to prescribe Latisse for the reasons noted above. Patients who wish to use Latisse may also become interested in neurotoxins and dermal fillers at some point, or they may refer friends or relatives who are interested in aesthetic procedures to you. Prescribing Latisse is a simple way to open the door to increased patient awareness regarding your total ophthalmic practice.

In my experience, Latisse grows longer, darker and thicker eyelashes in every patient who uses it regularly on a nightly basis. I tell my patients that once they are pleased with the quality of their lashes, usually after two to three months of nightly use, they can then reduce the frequency of their nightly application to a schedule that is appropriate for their desired results. If Latisse is discontinued, eyelashes will return to their pretreatment state.

Patient 2 at baseline prior to treatment.

Patient 2 after 16 weeks of daily treatments.

The Low-Risk Aesthetics Practice

All of my aesthetics-related patients call my office totally on their own in order to schedule their own appointments. From the beginning, I've conducted my aesthetics practice solely on a word-of-mouth basis and without spending even one cent on any advertising, marketing and/or promotional efforts.

This business model is a result of the fact that I entered the area of aesthetics by first finding an excellent mentor — a dermatologist friend who had extensive experience with the products and treatments then available. With his help, I avoided the classic mistakes of building a spa-like facility, buying expensive equipment, hiring additional staff and overspending on marketing — mistakes that many physicians make when getting into aesthetics.

I choose to limit my adjunct aesthetics practice to a threeday per week activity, which suits me perfectly in regard to the kind of work schedule that I desire in general and particularly in regard to the quality of life that I desire to live.

My adjunct aesthetics practice has made it possible and practical for me to operate my entire ophthalmic practice in a totally stress-free and enjoyable manner. I actually conduct my aesthetics practice with the support of merely one parttime employee.

Moreover, I maintain a "cancellation" list in order to quickly fill any and all aesthetics-related appointments that are unexpectedly cancelled, even at the last minute. In that regard, my "cancellation" list currently consists of more than 500 people (10% of whom are males) and who are eager to fill an appointment that has been unexpectedly cancelled.

Of course, being in a position to quickly fill a cancelled aesthetics-related appointment allows me to conduct my aesthetics related practice in an amazingly efficient and profitable manner. I am able to avoid having to suffer through repetitive periods of "dead" time.

Aesthetics Has Enriched My Practice

Based upon my experience concerning the success of my practice, as well as my experience related to conducting clinical trials, I enjoy the following benefits:

► I'm repeatedly asked to conduct clinical trials in regard to therapeutic medicine, as well as in regard to aesthetic treatments.

► I now possess a great deal of valuable experience relating to how to launch, grow and maintain an extremely successful adjunct aesthetics-related practice in addition to practicing as an ophthalmologist. I also possess a great deal of experience in regard to teaching other physicians how to follow in my footsteps.

Given the current need for ophthalmologists to become far more business-focused than ever before, there are numerous educational opportunities available to those physicians who are interested in learning how to build, grow and maintain a practice using neurotoxins, dermal fillers and collagen stimulators, as well as offering other fee-for-service aesthetically oriented procedures.

In closing, I no longer have to worry about the coming changes in regard to healthcare and medical practice because I'm not dependent on insurance companies or other thirdparty payers, nor am I worried about governmental interference regarding the way that I conduct any portion of my total ophthalmic practice. OM

Steven Yoelin practices in Newport Beach, Calif. He has professional and/or business relationships with Allergan, Bioform, Johnson and Johnson, Medicis and Sanofi Aventis. He will answer any questions concerning this article, if an e-mail communication is sent to him at syoelinmd@aol.com.