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The Art of the Eyes

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One busy practice set itself apart by creating a results-driven, combination eye treatment package that yielded better patient results and high patient satisfaction compared to typical non-surgical eye treatment options.

KIM NICHOLS, MD, FAAD, EMILY ANNE SCALISE, MA, AND MADISON BRADLEY, BS

It is often said that the periorbital cortex is a large component in non- verbal communication, especially in creating first impressions. Knowing that eye contact is the primary form of communication and interaction between individuals, rejuvenation of the periorbital area is highly desirable in the cosmetic world. This area is one of the first and most prominent areas to show signs of aging on the face due to the loss of tissue and bony resorption.1 Volume loss and discoloration in the under-eye area is very common and there are limited non-invasive, non-surgical treatment options that are effective in softening their appear- ance. At NicholsMD, we offer our patients comprehensive treatment packages that give the most effective results for a non-surgical solution. We have created a combination treatment to treat this delicate eye area in order to address collagen production, age prevention, and skin texture.

“Total Eye Rejuvenation” is a customized treatment that lifts and brightens the most central part of the face: the eyes. This treatment package is essential in order for patients to get the results they are looking for, which is almost always a more rested, lifted appearance. When choosing a candidate for this treatment, it is important to choose someone who is not only looking to improve the look of fine lines and wrinkles around the eyes, but also someone who is looking to open and lift the appearance of their brow and eye area.

TREATMENT

Total Eye Rejuvenation consists of one treatment of micro-focused ultrasound technology in the under-eye area, neurotoxin in the brow, forehead, and crow’s feet, and a hyaluronic acid dermal filler injected to the area.

Step 1: Micro-Focused Ultrasound Technology. Our micro-focused ultra- sound technology is a skin tightening device that uses ultrasound technology to stimulate, build, and restore collagen around the eyes. This allows for the improvement of the texture and elasticity of the skin under the eyes. Clinical trials have found that micro-focused ultrasound technology provides patients with 77.8 percent improvement of their fine lines and wrinkles, as well as volume loss.2 This part of the Total Eye Rejuvenation has virtually no downtime, while providing natural results in order to build collagen and tighten the skin. Our patients will see their full results within four to five months of the treatment. We recommend this treatment for all skin tightening concerns because it is non-invasive and only has to be done every one to one-and-a-half years.

BOTTOM LINE

The combined use of micro-focused ultrasound technology in the under- eye area, neurotoxin in the brow, forehead, and crow’s feet, and a hyaluronic acid dermal filler injected to the area can rejuvenate the eyes with minimum downtime.

Step 2: Neuromodulator. The next step of this treatment is the neurotoxin. The preference of the type of neurotoxin is at the discretion of the provider or preference of the patient based on past experiences. Each type of neuromodulating product has the same basic chemical makeup, differing from each other only by a small amino acid chain at the end of the molecule. These neurotoxins, or what we like to call wrinkle relaxers and reducers, help to lift the brow, while smoothing the lines on the forehead and eyes to give a natural, but more “awake” appearance. The full results of this part of the Total Eye Rejuvenation take 10-14 days to fully set in and can last up to three to four months on average. Unlike most offices, at NicholsMD, we inject Botox with insulin syringes to use the smallest possible needle. This, therefore, makes the injections more comfort- able while also reducing the risk of bruising.

Although bruising incidence and extent varies with every client and is hard to predict, before injecting we use our vein finder to indicate the larger veins in the treatment areas in order to avoid potential bruising. We also offer a complimentary Bruise-Minimizing Laser and Post-Procedure Cream within 10 days of the original appointment. We also have many options in office to help minimize the appearance of a bruise, such as soothing arnica masques, arnica pellets, and medical-grade, dermatologist-approved makeup available for purchase to disguise any signs of injection.

36 Ultherapy
37 Ultherapy

Step 3: Hyaluronic Acid Filler. The final part of the Total Eye Rejuvenation treatment is the placement of under-eye filler. We recommend hyaluronic acid dermal filler to add volume and fullness to the skin to correct moderate to severe volume loss. Most of our patients will require one syringe for optimal results. This part of the treatment will fill the hollows of the eye and improve the appearance of volume loss and discoloration. The under-eye filler lasts six to nine months on average and helps to subtly fill in lost volume of the under-eye area, reducing the appearance of dark circles and hollowing. Swelling of the under-eye area is normal after filler and typically lasts 24-72 hours. We recommend patients take a non-sedative antihistamine to help reduce the normal swelling. To reduce the number of “sticks” we do on our patient, we use cannulas to reduce incidence of bruising and sticking the patient multiple times. Studies have shown that the combination of hyaluronic acid filler and micro-focused ultrasound treatments provide the best result and most patient satisfaction.3

CONCLUSION

The Total Eye Rejuvenation combines these three techniques synergistically in order to enhance the patient’s periorbital area and make them feel like a more confident, more rested version of themselves. This treatment package also includes med- ical-grade eye cream and a professional hydrating concealer to hydrate the skin around and under eye, while providing 24-hour coverage.

For best results, we recommend that our patients adhere to the medical-grade skincare regimen designed just for them by our team of skincare experts. At NicholsMD, not only do we treat the patient’s concerns, but we also must ask for their compliance to our recommended skincare regimen in order for greater satisfac- tion and to help them maintain their results. With this being said, we offer an at-home solution that includes dermatologist-approved, medical- grade products to maintain their results.

Providing post-care instructions to our patients is pertinent to their overall satisfaction and results. We recommend the NicholsMD Total Eye Rescue bag to our patients in order for them to maintain their new fully rested look. Our rescue kit includes NicholsMD Gold under-eye masques, a silk eye mask, NicholsMD under-eye ice packs along with a de-puffing eye gel.

We strive to provide boutique-like service that gives patients natural- looking results and allows them to finally look rested.

NicholsMD is a dermatology office owned by board-certified dermatologist, Dr. Kim Nichols. A dermatologist is a doctor who specializes in treatments relating to hair, skin, and nails. Under Dr. Nichols’ supervision, NicholsMD has trained professional staff members which include physician assistants, medical assistants, and a medical aesthetician all whom have been person- ally trained by Dr. Nichols.

Dr. Nichols is an esteemed injector in the field of dermatology. She is a physician trainer for companies like Allergan and trains other physicians on how to inject filler safely and effectively for natural-looking results.

1. Bravo, B., Rocha, C., Bastos, J., & Silva, P. (2015). Comprehensive treatment of periorbital region with hyaluronic acid. The Journal of clinical and aesthetic dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479367/.

2. Ruiz-Esparza, J. (2006). Noninvasive skin Tightening induced By Radio frequency and infrared light devices. Cutaneous and Cosmetic Laser Surgery, 325–347. https://doi.org/10.1016/b978-0-323-03312-1.50020-3

3. Barbarino, S. C. (2020). Combination approach to tear trough deformities and under eye appearance using microfocused ultrasound with visualization and hyaluronic acid filler. The American Journal of Cosmetic Surgery, 074880682094758.

KIM NICHOLS, MD, FAAD
Board-certified dermatologist and proud entrepreneur.
Owner of NicholsMD of Greenwich and SkinLab by NicholsMD
Graduate of Harvard University and NYU Medical School.

EMILY ANNE SCALISE, MA
Director at NicholsMD of Greenwich and SkinLab by NicholsMD.
Graduate of Columbia University
Active practice management speaker.

MADISON BRADLEY, BS
Medical Assistant at NicholsMD of Greenwich.
Bachelor of Science degree in Biology from Sacred Heart University; preparing for medical school.

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