Can New Eye Treatment Really Provide Eyelid Lift Without Surgery?
I like to think of myself as a generally positive person for the body and the face: I don’t have a scale, I wear makeup often, and I keep my self-talk quite sympathetic. But I hate my eyelids. Currently, my upper eyelids rest uncomfortably close to my lower eyelids and have descended into slow and constant sagging, a common condition called acquired ptosis or blepharoptosis, which affects about 11.5% of adults. Sometimes this can be caused by using long term contact lenses; but most often the condition is brought on by age and may even obstruct vision in severe cases, turn an elective eye lift procedure into a non-elective procedure in insurance jargon.
While I’m not quite ready to plead my case with Aetna, my wearing a mask in the pandemic era has certainly made my own ptosis more visible, with relentless Zoom calls only amplifying my sleepy reflection. (The Zoom Effect, which contributed to the facial rejuvenation boom, is now well documented and, among other things, has included an increased interest in eyelid surgery, which was already the third most popular cosmetic surgery procedure in the States. – United in 2019, according to the American Society of Plastic Surgeons.) And with the idea of a scalpel so close to my unappealing sclera anyway, I’ve come to accept that there’s a limit to what I can do with my lower eyelids. Then a friend obsessed with treatment brought me up to speed on a new remedy in the fight against gravity: the badly named but intriguing Upneeq.
FDA approved over the summer for consumer use, prescription-only “Gout Lifts” is designed to be administered once daily and is ready to do for the eyelids. Latisse made for eyelashes. Upneeq contains oxymetazoline hydrochloride, a vasoconstrictor that causes the Müllerian muscle, one of the two muscles that open the eyelid, to contract, creating movement that lasts about six hours. Non-invasive and proven to start working in minutes, its promise seems almost too good to be true. Sure enough, some due diligence leads me to an anxiety-provoking discovery: Oxymetazoline hydrochloride is actually the same active ingredient in over-the-counter nasal spray. Eek.
“It is wise to be worried and question what you are throwing in your eyes,” says Suzanne Freitag, MD, the famous director of ophthalmic plastic surgery at the Massachusetts Eye and Ear, affiliated with Harvard, who validates my concerns about Zoom. Freitag crosses my face on the screen and says my ptosis is noticeable but slight. “The real eyelid itself goes lower than we’d like,” she notes, “but it’s different to have excess skin overhanging” – and makes me a perfect candidate for Upneeq, the first research which Freitag took a close look at: In clinical trials, 84 percent of patients experienced measurable improvement in as little as two hours, and only 1 to 5 percent of patients reported common side effects, such as redness and irritation. Freitag is also optimistic about Upneeq’s off-label potential to correct a condition that scares the hearts of Botox users everywhere: the dreaded “droopy eyelid,” which can occur if the toxin drifts or is injected incorrectly, causing eyelid or eyebrow to droop, until it leaves your system, which can take months. (According to a study cited in Journal of Clinical and Aesthetic Dermatology in 2016, this occurs in around 5% of users.)
A little reassured, I visit Manhattan, cosmetic surgeon and oculofacial plastic surgeon Brett Kotlus, MD, in her immaculate Upper East Side office, decorated in a calming, clinical palette of light gray and white. Spotify’s low-key ‘Coffee Shop’ playlist whispers in the background as Kotlus twists the top of Upneeq’s small, foil-wrapped single-use bottle. A slight panic runs through my body. Why do I use nasal decongestant on purpose in my eyes? But before I could jump off the chair, Kotlus thoroughly soaked in the liquid, explaining that contact lens users have to remove their lenses and wait 15 minutes after application to put them back on.
After five minutes, it produces a mirror. “See how it makes your eyes shine a little?” I do, I tell him as I examine my reflection with pleasure to see a lift of about a millimeter compared to the five or six millimeters Kotlus says he can achieve with the surgery. The effect is like a nap in a bottle. “You send the message to be more alert,” he said, “but that doesn’t call attention to itself like, ‘Hey look what I’ve done’. “