Ocular Aesthetics for Diverse Populations

Beauty ideals, cultural norms, skin coloring, and patient expectations are not universal in our country, as it is comprised of a diverse population. In fact, 58% of the population is non-Hispanic White, 20% is Hispanic, 13% is Black, 6% is Asian or Pacific Islander, and 3% is other, according to recent data.¹ In understanding this, and that cosmetic concerns are often related to adnexal and ocular surface health, optometrists are uniquely positioned to alleviate dry eye disease (DED) symptoms while providing ocular cosmesis.^2,3 Here, I discuss how.

INQUIRE ABOUT BEAUTY PRACTICES

In diverse patient populations, beauty practices may vary by region and social norms. As an example, people in Africa, Asia, and the Middle East use kajal (a black semisolid material), collyrium (eye salve for infections), and surma or kohl (fine powders) to protect their eyes and treat common ailments (Figure 1).² (Incidentally, the FDA has named most of these items as illegal color additives, in part because they appear to contain high levels of lead.⁴) Using these items may contribute to tear film instability, meibomian gland dysfunction, blepharitis, periocular dermatitis, keratitis, and chronic ocular irritation.²

Also, patients may not volunteer certain information—that they use tightlining (eyeliner on the inner rim of the eyelid) and lash serums, wear lash extensions, or have undergone eyelid tattooing (permanent eyeliner) or lash dyeing—unless asked directly.

For example, eyelid tattooing may impact the safety of procedures, such as intense pulsed light (IPL), as pigment within the skin can absorb light energy, which can increase the risk of localized overheating, burns, or pigment alteration. As a result, we should conduct respectful, specific patient questioning to uncover habits that may influence ocular surface health and comfort or procedure safety. As an example: “Have you used any products or had any treatments, such as inner-rim eyeliner (tightlining), lash serums, extensions, eyelid tattooing, or lash tinting, along your eyelid margin?” Remember that an aesthetic history is also a DED history.

IDENTIFY CHROMOPHORES

When it comes to employing IPL or low-level light therapy (LLLT) devices, understand what chromophores your energy-based device is targeting (Figure 2 and Table). Fully using the energy you are applying to specific chromophores gives the patient the best possible outcome in a safe and effective manner.

Regarding IPL, patients who have higher epidermal melanin carry a greater risk of postinflammatory hyperpigmentation, hypopigmentation, and unintended thermal injury (skin types V and VI). In the periocular region, where the skin is thin and highly visible, those risks are especially important to assess.

LLLT is considered safe across all skin types (I–VI) for ocular surface disease and periocular applications, as it is not melanin-dependent. Patient screening should include photosensitivity, uncontrolled seizure disorders (IPL can trigger seizures), and active ocular or periocular infection.

Although generally well-tolerated, potential adverse effects include, but are not limited to, mild skin irritation, contact dermatitis, acneiform eruptions, and, rarely, burns or ocular injury without proper eye protection. Treatment parameters vary by device and should be selected based on the clinical indication.^1,5

RF is targeting water, so it can be used across all skin types (Figure 3). Therefore, in a diverse patient population, that broader usability can be clinically useful when light-based treatment is less appropriate or when periocular laxity and skin quality may cause DED and a source of aesthetic dissatisfaction.^2,5,6

In addition to RF, a device is available that provides dynamic muscle electrostimulation to address low lid tone, lid support, and periocular muscle function (Figure 4). It can be especially beneficial in patients whose appearance-related concerns overlap with eyelid positioning, laxity, or exposure-related symptoms. In this context, lid position has functional significance beyond appearance, with implications for blink mechanics, ocular surface exposure, and patient comfort.⁵

START WITH FUNCTION

Ocular aesthetics should begin with function and build thoughtfully from there. In a diverse patient population, that means questioning patients about their beauty habits and selecting treatments that improve ocular surface health and periocular function, and provide an aesthetic benefit.