February 15, 2007
7 min read

Aesthetics opportunities generate growth for ophthalmic industry

Ophthalmic companies offer cosmetic products that address ophthalmologists’ growing interest in aesthetics.

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As the aesthetics market grows in several medical specialties, including ophthalmology, members of the ophthalmic industry are responding by expanding their offerings in this area.

Ocular Surgery News spoke to representatives at two ophthalmic companies that are participating in the aesthetics market, Allergan and Iridex, about their current status and future plans.

Barry Caldwell
Barry Caldwell

Allergan is currently the largest medical aesthetics company in both the United States and Europe, according to Julian Gangolli, Allergan’s corporate vice president and president for North America, largely due to its flagship aesthetics product, Botox (botulinum toxin type A). The company also more recently has added the facial filler Juvéderm (hyaluronic acid) to its product line through the acquisition of Inamed. Juvéderm was approved by the U.S. Food and Drug Administration in June.

Iridex entered the cosmetic lasers market about 10 years ago and recently acquired Laserscope to expand its offerings, according to Barry Caldwell, president and chief executive officer of Iridex.

Other companies are also expanding their aesthetics product lines. Angiotech, a specialty pharmaceutical company, last year acquired the Contour Threads product line in the acquisition of its wholly owned subsidiary Surgical Specialties. The barbed sutures, which are used in aesthetic as well as plastic and reconstructive surgical procedures, last year received the CE Mark and are now being marketed in Europe and the United States.

A growing market

Aesthetics products for both pharmaceutical and laser treatments have slowly entered the ophthalmic market since the 1990s.

In the late ‘80s, Jean D. Carruthers, MD, FRCS(C), FRC(OPHTH), an ophthalmologist, and her dermatologist husband Alistair Carruthers, MD, observed that botulinum toxin A — at that time marketed by Allergan as Oculinum — could be used not only to treat blepharospasm but also to soften glabellar lines. When the FDA approved Botox Cosmetic for that indication in 2002, Allergan entered into the medical aesthetic arena.

Following on the success of Botox, Mr. Gangolli said, Allergan has now acquired Inamed and released Juvéderm to compete against Restylane (hyaluronic acid, Medicis), which has been on the U.S. market since its FDA approval in 2003.

Julian Gangoli
Julian Gangoli

“The growth we’re seeing in the aesthetics market is being driven not only by the aging of the baby boom generation, but also by the growing demand among all age groups for safe and effective approaches to maintaining a healthy and youthful appearance and self-image,” he said.

Allergan recently commissioned an international survey whose results support that claim, Mr. Gangolli said. Examining the beauty and grooming habits of 10,000 women and men, the survey found that eight out of 10 women across the U.S. and Europe report that they do not necessarily want to look younger. Instead, he said, they want to look naturally good for their age and have their face reflect their personality, expressions and emotional well-being.

“This reinforces a new and important trend in the perception of beauty and suggests that the quest for wrinkle-free perfection is coming to an end,” Mr. Gangolli said. Surgical and nonsurgical aesthetic procedures have grown an average of 41% over the past 2 years, he added.

“The increasing acceptance of aesthetic procedures is, in many ways, a direct consequence of how far new techniques in clinical practice and scientific advances have taken us in our ability to provide an increasing range of — and accessibility to — safe and effective treatments, from less invasive surgical procedures and techniques to next-generation innovations in dermal fillers,” Mr. Gangolli said. “While medical aesthetics is among the fastest growing sectors in the health care arena, it is still a largely untapped market with enormous growth potential. For example, the number of dermal filler procedures performed in the U.S. is still just half the number recorded in Europe.”

Mr. Gangolli attributed that to the limited choice until recently in collagen and hyaluronic acid dermal filler products.

Laser growth

Mr. Caldwell of Iridex said the company was founded about 18 years ago and became well established among retinal specialists with its green and infrared lasers. In the mid-1990s, the company realized that its lasers used some of the same wavelengths being utilized in other medical specialties, including the aesthetics field.

“We began basically taking the same laser design that we had in ophthalmology and repurposing it to aesthetics,” Mr. Caldwell said. “With more products from which to spread overhead and to build infrastructure, it has been very helpful over the years, particularly since the competency in manufacturing and design are virtually the same between the ophthalmology and aesthetics technologies. It’s been basically a sharing of resources to accomplish additional revenues for the company.”

Mr. Caldwell said the company made the decision to expand, through its purchase of Laserscope, because its previous product offerings treated only about 30% of aesthetic conditions.

“We couldn’t go after deep veins. We didn’t have a hair-removal product. We didn’t have a skin-tightening product,” he explained. “With the acquisition of the Laserscope aesthetics business, we’ve got a broad range of products to offer across all the laser cosmetic procedures that are performed today. The Gemini multi-application laser system is FDA approved for performing 93% of the most common aesthetics procedures.”

Future endeavors

While neither executive had specific numbers on the growth of aesthetics in ophthalmology, they said they have observed growing interest in the field.

“There is plenty of room for growth in the use of facial aesthetic products in the ophthalmology category, and attendance at [the oculoplastics session during] the Hawaiian Eye 2007 Subspecialty Saturday demonstrated the keen interest ophthalmologists have in this growing area,” Mr. Gangolli said. “The presenting faculty addressed a packed house of ophthalmologists.”

Mr. Caldwell said more and more ophthalmologists, although still relatively small in number, are beginning to realize the opportunities available in the aesthetic realm.

“In 2006, we sold three aesthetics lasers to ophthalmologists,” he said. “These were ophthalmologists who have refractive practices.”

He suggested that ophthalmologists who are already focusing on refractive surgery can expand into aesthetics relatively easily. (See sidebar)

“As these cosmetic or aesthetic procedures have evolved, it’s becoming easier for any specialty to get into it, and an ophthalmologist is a trusted physician and he’s working on the face,” Mr. Caldwell said. “There are certainly opportunities for them to add aesthetic procedures to their practice, and it’s virtually all elective.”

He added that, in the future, Iridex will be considering adding other light-based technologies — not necessarily lasers — with applications in ophthalmology or aesthetics.

Mr. Gangolli said Allergan will continue to consider opportunities that offer high market growth potential and innovation in line with the company’s strategic goals and will continue to seek partnerships in ophthalmology, medical aesthetics and neurosciences, as well as other emerging markets.

For more information:
  • Julian Gangolli, the corporate vice president of Allergan and president of Allergan North America, can be reached at 2525 Dupont Drive, Irvine, CA 92612-1599; 714-246-5108; fax: 714-246-5888; e-mail: Gangolli_Julian@allergan.com.
  • Barry Caldwell, the president and chief executive officer of Iridex Corporation, can be reached at 1212 Terra Bella Ave., Mountain View, CA 94043; 650-940-4700; fax: 650-940-4710; e-mail: BCaldwell@iridex.com.
  • Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.

Incorporating aesthetics requires skill, dedication

By Katrina Altersitz

Deborah Sherman, MD
Deborah Sherman

As companies expand their aesthetics product lines, more ophthalmologists are beginning to see the benefits of performing aesthetic procedures in their practices.

Ocular Surgery News spoke to James Dawes,a practice manager, and Deborah Sherman, MD, an oculoplastic surgeon, about how ophthalmologists can incorporate aesthetics into their practices.

“When you look at the entire aesthetics market across the country, more and more people are having cosmetic surgery at an earlier age,” Mr. Dawes said. “It’s not just a 65-year-old looking for a facelift. It may be a 40-year-old who wants a mini-facelift or just wants Botox (botulinum toxin type A, Allergan). It may be a 30-year-old who wants Botox as a wrinkle-prevention device. The entire market is growing because more and more people are having the procedures at a younger age and, with the amount of publicity and reality TV shows, the stigma associated with cosmetic surgery has gone away.”

Mr. Dawes said the cataract and refractive surgical practice he manages in Florida brought in an oculoplastics specialist 8 years ago and has since added other cosmetic services such as hair transplantation, dermatology and skin-care treatments, often performed by a full-time aesthetician.

Dr. Sherman agreed that this is “an exciting time” for ophthalmologists who are interested in offering aesthetic procedures to their patients, as new rejuvenating techniques emerge.

“Now we have things we can offer truly in one office visit that can change people’s lives and give them a fresh look, a new beginning, that little edge of confidence to allow them to go out and be the best that they can be,” she said.

Ophthalmologists are ideal practitioners of aesthetic treatments because of their background in surgical procedures around the eye, Dr. Sherman said. Still, they must undergo the right training.

“We’re very adept and, as surgeons, we use very meticulous techniques and we use instruments frequently,” she explained. “From a manual dexterity standpoint, we’re at the premier level of technique, so it’s very easy for an eye doctor to feel at home once they’ve received the proper training.”

Receiving that training, learning the market and dedicating one’s practice to pleasing the customer are important factors for success in aesthetics, Dr. Sherman and Mr. Dawes said.

“If an eye surgeon is considering entering into the aesthetics field, I think the message is, do your homework,” Dr. Sherman said. “See what your market is. Ask your patients.”

She continued, “The second question is, what training do I need to be the best? Even though as an ophthalmologist you have the aptitude, you have to make sure you get the training as well.”

Mr. Dawes said that many people enter the aesthetics market assuming a high profit margin is guaranteed, but that is not the case.

“What is different about the aesthetics business that a lot of practices don’t get or won’t get is that you really have to reinvent your business,” he said. “You can’t provide the same standard of customer service that you provided to your cataract patients over the years.”

From the physical facility to the staff, Mr. Dawes said, everything must emit an air of luxury worthy of the high prices patients will be paying out of pocket.

Mr. Dawes said the physicians he works with consider aesthetics to be an extension of their services and a way to serve the whole patient to improve their quality of life.

“For example,” he said, “a patient who had a cataract and had cloudy vision for years, when they no longer have the cataract because of cataract surgery, a lot of the times they will detect changes in their appearance that they didn’t notice before. This gives us an opportunity to help them feel better about themselves, have a higher self-esteem and really improve their quality of life.”

For more information:
  • James Dawes can be reached at the Center for Sight, 1360 East Venice Ave., Venice, FL 34285; 941-480-2105; e-mail: jdawes@centerforsight.net.
  • Deborah Sherman, MD, can be reached at the Sherman Aesthetic Center, 4306 Harding Pike, No. 106, Nashville, TN 37205; 615-297-5798; e-mail: drdeborahsherman@bellsouth.net.